The performance of intensive care units: does good management make a difference?

摘要: A significant portion of health care resources are spent in intensive units with, historically, up to two-fold variation risk-adjusted mortality. Technological, demographic, and social forces likely lead an increased volume the future. Thus, it is important identify ways more efficiently managing reducing patient outcomes. Based on data collected from 17,440 patients across 42 ICUs, present study examines factors associated with mortality, average length stay, nurse turnover, evaluated technical quality care, ability meet family member needs. Using Apache III methodology for risk-adjustment, findings reveal that: 1) technological availability significantly lower mortality (beta = -.42); 2) diagnostic diversity greater .46); 3) caregiver interaction comprising culture, leadership, coordination, communication, conflict management abilities unit stay .34), turnover -.36), higher .81), needs .74). Furthermore, be hospitals that profitable, involved teaching activities, have leaders actively participating hospital-wide improvement activities. The hold a number managerial policy implications regarding adoption, specialization, among ICU team members. They suggest intervention "leverage points" givers, managers, external makers efforts continuously improve outcomes care.