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Defining a High-Performance ICU System for the 21st Century: A Position Paper

1998; SAGE Publishing; Volume: 13; Issue: 4 Linguagem: Inglês

10.1177/088506669801300407

1525-1489

Daniel Teres, Thomas L. Higgins, Jay S. Steingrub, Laurie Loiacono, William T. McGee, Lori Circeo, Mary Brunton, Karen K. Giuliano, Marty Burns, Jean Roger Le Gall, Antonio Artigas, Martin A. Strosberg, Stanley Lemeshow,

Cardiac Arrest and Resuscitation

In the fall of 1997 George D. Lundberg and John E. Wennberg wrote an editorial in JAMA calling for comprehensive quality improvement programs to become the driver of the American health care system. The suggestion came during the Second European Forum on Quality Improvement in Health Care held in Paris, France, in April 1997 and was based on comments made by Donald Berwick. The concept was to focus on an organized response to problem identification and proposed solutions to improve patient care and protect the health of the public. Critical care medicine represents a large segment of health care and is undergoing dramatic changes during our managed care revolution. General ICU severity of illness models have been developed, tested, and shown to provide a useful estimate of hospital mortality for populations of critically ill patients. These systems have captured the imagination of clinical researchers and have become an integral component of a large number of publications as well as a part of many ICU databases. These risk adjustment severity models are remarkably robust for heterogeneous patient populations but the models have not been shown to validate well in new settings. We feel that by focusing on the episode of critical illness rather than each individual ICU admission and by going beyond the traditional acute hospital discharge to determine whether the patient lives or dies, we can better evaluate critical care system performance and cost-effectiveness. The incentives for high quality/low cost should favor integrated comprehensive critical care delivery systems. Programs that score well should be identified as high quality and be honored as medallion level 1 ICUs. We challenge national and international critical care societies to evaluate and then debate the described definitions and recommendations as a call to action.