Perez d'Empaire Pablo Adolfo, Kajdacsy-Balla Amaral Andre Carlos
Crit Care. 2012 Dec 10;16(6):244. doi: 10.1186/cc11821.
Increasing complexity and costs are a fundamental problem in critical care medicine, leading researchers to study opportunities and threats to continue to provide high-quality care in a more efficient health system. Over the past decades, we have learned from industrial methods that quality improvement and resource management can help achieve these results. Last year, Critical Care published a number of papers that highlight key points of critical care resource management. Each of these is grouped into one of three broad categories, based on domains of quality: (a) outcomes, in which we review long-term outcome data with an emphasis on the aging population, strategies to help mitigate the psychological burden of critical care, adverse events, and the appropriate use of resources, such as prolonged mechanical ventilation and intensive care unit (ICU) beds; (b) processes of care, in which we review variability in the provision of critical care, owing to gender, insurance status, and delays in ICU admission; knowledge translation studies in critical care; goal-directed therapy for postoperative patients and decision-making in the ICU; and (c) structure, in which we review strategies to improve quality through changes in design and the structural limitations to provide care in resource-limited settings.
日益增加的复杂性和成本是重症医学中的一个基本问题,促使研究人员去研究在一个更高效的卫生系统中继续提供高质量护理所面临的机遇和威胁。在过去几十年里,我们从工业方法中学到,质量改进和资源管理有助于实现这些目标。去年,《重症护理》发表了多篇强调重症护理资源管理要点的论文。根据质量领域,每篇论文都被归入三大类中的一类:(a) 结果,我们在此回顾长期结果数据,重点关注老年人群、减轻重症护理心理负担的策略、不良事件以及资源的合理使用,如长时间机械通气和重症监护病房(ICU)床位;(b) 护理过程,我们在此回顾因性别、保险状况和ICU入院延迟导致的重症护理提供方面的差异;重症护理中的知识转化研究;术后患者的目标导向治疗以及ICU中的决策;(c) 结构,我们在此回顾通过设计改变来提高质量的策略以及在资源有限环境中提供护理的结构限制。