Annual Meeting of the American Association for the Surgery of Trauma and the Trauma Association of Canada. Baltimore, MD, USA, 1998/09/24.
Decreasing reimbursement provided by third-party payors necessitates reduction of costs for providing critical care services.
If academic medical centers are to remain viable, methods must be instituted that allow cost reduction through practice change.
We used short cycle improvement methodology to rapidly achieve these goals.
Short cycle improvement methodology involves identifying the areas for improvement, defining a mechanism to evaluate outcome, initiating an improvement plan on a small number of patients, and repeating the cycle with new adjustments based on outcome.
Baseline data on areas for improvement was prospectively collected, and protocols to initiate change were developed and tested by short improvement cycles.
Outcomes were evaluated, protocols were modified, and another cycle was performed.
This methodology was continued until the desired goals had been achieved.
To adjust outcomes for severity of illness, Acute Physiology and Chronic Health Evaluation II methodology was used.
Using this methodology, we focused on three areas for improvement.
Standing orders for laboratory studies, electrocardiograms, and chest x-ray films were eliminated.
Protocols were developed for the appropriate use of sedation, analgesics, and neuromuscular blocking agents.
Finally, a protocol for weaning from mechanical ventilation was developed to allow respiratory therapists to proceed through the weaning process, which was ordered by a physician. (...)
Mots-clés Pascal : Unité soin intensif, Diminution coût, Amélioration, Pronostic, Centre hospitalier universitaire, Méthodologie, Economie santé, Homme, Malade
Mots-clés Pascal anglais : Intensive care unit, Cost lowering, Improvement, Prognosis, Teaching hospital, Methodology, Health economy, Human, Patient
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0240779
Code Inist : 002B30A04B. Création : 16/11/1999.