The impact of a multidisciplinary approach on caring for ventilator-dependent patients
International Journal for Quality in Health CarePublished 1 February 1998
Michael Young, Valerie J. Gooder, Mark Oltermann, C. B. Bohman, Thomas K. French, Brent C. James
Citations70
SJR quartileQ2
SJR score0.85
SNIP1.11
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TL;DR
Implementation of a structured multidisciplinary care model to care for a heterogeneous population of ventilator-dependent ICU patients was associated with significant reductions in ICU and hospital lengths of stay, charges, and costs.
Abstract
Implementation of a structured multidisciplinary care model to care for a heterogeneous population of ventilator-dependent ICU patients was associated with significant reductions in ICU and hospital lengths of stay, charges, and costs. Mortality rates were unaffected.
Keywords
Medicine
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