Zimmerman J E, Rousseau D M, Duffy J, Devers K, Gillies R R, Wagner D P, Draper E A, Shortell S M, Knaus W A
Department of Anesthesiology, George Washington University Medical Center, Washington, DC 20037.
Am J Crit Care. 1994 Mar;3(2):129-38.
To examine structural and organizational characteristics at two ICUs with marked differences in risk-adjusted survival.
We performed on-site organizational analysis in two ICUs at two major teaching hospitals. Our main outcome measures were interviews and direct observations by a team of clinical and organizational researchers; demographic, clinical, and survival data for 888 ICU admissions; and questionnaire responses from 70 nurses and 42 physicians on ICU structure and organization. ICU performance was measured using risk-adjusted survival and the ratios of actual to predicted ICU length of stay and resource use.
Structural and organizational questionnaires, self-evaluation by staff members, and the research team's implicit judgments following detailed on-site analysis failed to distinguish units with higher and lower risk-adjusted survival. Both units exhibited practices to emulate and practices to avoid.
The methods used in this study can identify organizational problems and potential means for improvement. The best practices and suggestions for improvement at these units provide examples of methods for improving ICU management.
研究两家重症监护病房（ICU）的结构和组织特征，这两家ICU在风险调整后的生存率方面存在显著差异。
我们在两家大型教学医院的ICU进行了现场组织分析。主要的结果指标包括由一组临床和组织研究人员进行的访谈和直接观察；888例ICU入院患者的人口统计学、临床和生存数据；以及70名护士和42名医生对ICU结构和组织的问卷调查回复。ICU的绩效通过风险调整后的生存率以及实际与预测的ICU住院时间和资源使用比率来衡量。
结构和组织问卷、工作人员的自我评估以及研究团队在详细现场分析后的隐性判断均未能区分风险调整后生存率较高和较低的单位。两个单位都有值得效仿的做法和需要避免的做法。
本研究中使用的方法可以识别组织问题和潜在的改进方法。这些单位的最佳实践和改进建议为改善ICU管理的方法提供了示例。
