1 Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
Ann Am Thorac Soc. 2014 Mar;11(3):454-7. doi: 10.1513/AnnalsATS.201311-393AS.
Reaping the optimal rewards from any quality improvement project mandates sustainability after the initial implementation. In Part III of this three-part ATS Seminars series, we discuss strategies to create a culture for change, improve cooperation and interaction between multidisciplinary teams of clinicians, and position the intensive care unit (ICU) optimally within the hospital environment. Coaches are used throughout other industries to help professionals assess and continually improve upon their practice; use of this strategy is as of yet infrequent in health care, but would be easily transferable and potentially beneficial to ICU managers and clinicians alike. Similarly, activities focused on improving teamwork are commonplace outside of health care. Simulation training and classroom education about key components of successful team functioning are known to result in improvements. In addition to creating an ICU environment in which individuals and teams of clinicians perform well, ICU managers must position the ICU to function well within the hospital system. It is important to move away from the notion of a standalone ("siloed") ICU to one that is well integrated into the rest of the institution. Creating a "pull-system" (in which participants are active in searching out needed resources and admitting patients) can help ICU managers both provide better care for the critically ill and strengthen relationships with non-ICU staff. Although not necessary, there is potential upside to creating a unified critical care service to assist with achieving these ends.
从任何质量改进项目中获得最佳回报都需要在初始实施后保持可持续性。在这个由三部分组成的 ATS Seminars 系列的第三部分中，我们将讨论创建变革文化、改善临床多学科团队之间的合作与互动以及在医院环境中优化重症监护病房（ICU）的策略。教练在其他行业中被广泛用于帮助专业人士评估和不断改进他们的实践；这种策略在医疗保健领域尚未得到广泛应用，但很容易转移并可能使 ICU 经理和临床医生都受益。同样，关注改善团队合作的活动在医疗保健领域之外也很常见。众所周知，模拟培训和关于成功团队运作关键要素的课堂教育可以带来改进。除了营造一个个人和临床团队表现出色的 ICU 环境外，ICU 经理还必须使 ICU 能够在医院系统中良好运作。重要的是要摒弃独立的（“筒仓式”）ICU 的概念，转而采用与整个机构紧密结合的 ICU。创建一个“拉动系统”（其中参与者积极寻找所需资源并收治患者）可以帮助 ICU 经理为危重病患者提供更好的护理，并加强与非 ICU 工作人员的关系。虽然不是必需的，但创建一个统一的重症监护服务有可能帮助实现这些目标。
