1 Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Ann Am Thorac Soc. 2014 Feb;11(2):264-9. doi: 10.1513/AnnalsATS.201306-177AS.
The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives. These tools are relevant to health care today as focus is placed on limiting low-value care and measuring, reporting, and improving quality. In the ICU, the complexity of illness and the need to standardize processes make these tools even more appealing. Herein, we highlight four techniques to help prioritize initiatives. First, the "80/20 rule" mandates focus on the few (20%) interventions likely to drive the majority (80%) of improvement. Second, benchmarking--a process of comparison with peer units or institutions--is essential to identifying areas of strength and weakness. Third, root cause analyses, in which structured retrospective reviews of negative events are performed, can be used to identify and fix systems errors. Finally, failure mode and effects analysis--a process aimed at prospectively identifying potential sources of error--allows for systems fixes to be instituted in advance to prevent negative outcomes. These techniques originated in fields other than health care, yet adoption has and can help ICU managers prioritize issues for quality improvement.
商业界已经制定了策略，以确保他们所生产的商品或服务的质量，并改善多学科工作团队的管理。经过修改，这些技术中的许多都可以引入重症监护病房（ICU），以改善临床运营和患者安全。在 ATS 研讨会系列的第三部分的第一部分中，我们主张在 ICU 中采用企业管理策略，并提出了针对选定质量改进计划的策略。这些工具在当今的医疗保健中是相关的，因为重点是限制低价值的护理，并衡量、报告和改进质量。在 ICU 中，疾病的复杂性和标准化流程的需求使得这些工具更加吸引人。在这里，我们强调了四种技术来帮助确定优先事项。首先，“80/20 规则”要求关注可能推动大部分（80%）改进的少数（20%）干预措施。其次，基准测试——与同行单位或机构进行比较的过程——对于确定优势和劣势领域至关重要。第三，根本原因分析，即对负面事件进行结构化回顾的过程，可以用于识别和修复系统错误。最后，失效模式和影响分析——旨在前瞻性地识别潜在错误源的过程——可以提前进行系统修复，以防止负面结果。这些技术最初起源于医疗保健以外的领域，但采用这些技术并有助于 ICU 管理人员确定质量改进的优先事项。
