Advertisement

Hospital and ICU Organizational Structure and Quality of Care for Surgical Patients

  • J. B. Dimick
  • P. J. Pronovost
  • P. A. Lipsett
Conference paper

Abstract

The quality of care for surgical patients varies depending on where they choose to receive their operation [1–3]. In the United States, two recent reports from the Institute of Medicine (IOM) have focused on the frequency of medical errors and the poor quality of health care services received by some patients. In the first report issued in 1998 “To Err is Human: Building a Safer Health System” [2], the IOM committee concluded that between 44000 and 98000 Americans die each year as a result of medical errors. These estimates were based largely on two population-based investigations [2]. One of these studies, conducted in the large states of Utah and Colorado, demonstrated that 2.9% of hospitalized patients experience adverse events. Of these adverse events, 6.6% lead to death and more than half of these adverse events were related to medical errors that could have been prevented.

Keywords

Hospital Volume Physician Staffing Abdominal Aortic Surgery Daily Round Provider Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Chassin M, Galvin RW (1998) The urgent need to improve health care quality. Institute of Medicine national roundtable on health care quality. JAMA 280: 1000–1005PubMedCrossRefGoogle Scholar
  2. 2.
    Institute of Medicine (1998) To Err is Human: Building a Safer Health System. National Academy Press, WashingtonGoogle Scholar
  3. 3.
    Institute of Medicine (2001) Crossing the Quality Chasm: A New Health System for the Twenty-first Century. National Academy Press, WashingtonGoogle Scholar
  4. 4.
    Pronovost PJ, Garrett E, Dorman T, et al (2001) Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery. Langenbecks Arch Surg 386: 249–256PubMedCrossRefGoogle Scholar
  5. 5.
    Dimick JB, Stanley JC, Axelrod DA, et al (2002) Variation in death rate after abdominal aortic aneurysmectomy in the United States: Impact of hospital volume, gender, and age. Ann Surg 235: 579–585PubMedCrossRefGoogle Scholar
  6. 6.
    Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA (2003) Postoperative complication rates after hepatic resection in Maryland hospitals. Arch Surg 138: 41–46PubMedCrossRefGoogle Scholar
  7. 7.
    Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA (2003) Surgical volume and quality of care for esophageal resection: Do high-volume hospitals have fewer complications? Ann Thorac Surg (in press)Google Scholar
  8. 8.
    Weingart SN, Iezzoni LI, Davis RB, et al (2002) Use of administrative data to find substandard care: validation of the complications screening program. Med Care 38: 796–806CrossRefGoogle Scholar
  9. 9.
    Lawthers AG, McCarthy EP, Davis RB, Peterson LE, Palmer RH, Iezzoni LI (2000) Identification of in-hospital complications from claims data. Is it valid? Med Care 38: 785–795PubMedCrossRefGoogle Scholar
  10. 10.
    Donabedian A (1980) Explorations in Quality Assessment and Monitoring. Vol. 1. The Definition of Quality and Approaches to its Assessment. Health Administration Press, Ann ArborGoogle Scholar
  11. 11.
    Dimick JB, Pronovost PJ, Heitmiller RF, Lipsett PA (2001) Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection. Crit Care Med 29: 753–758PubMedCrossRefGoogle Scholar
  12. 12.
    Dimick JB, Pronovost PJ, Lipsett PA (2002) The effect of ICU physician staffing and hospital volume on outcomes after hepatic resection. J Intensive Care Med 17: 41–47Google Scholar
  13. 13.
    Pronovost PJ, Jenckes MW, Dorman T, et al (1999) Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 281: 1310–1317PubMedCrossRefGoogle Scholar
  14. 14.
    Reynolds NH, Haupt MT, Thill-Baharozian M, Carlson RW (1998) Impact of critical care physician staffing on patients with septic shock in a university hospital medical intensive care unit. JAMA 260: 3446–3450CrossRefGoogle Scholar
  15. 15.
    Li TCM, Phillips MC, Shaw L, Cook FE, Natanson C, Goldman L (1984) On-site Physician Staffing in a Community Hospital Intensive Care Unit. JAMA 252: 2023–2027PubMedCrossRefGoogle Scholar
  16. 16.
    Pollack MM, Katz RW, Ruttiman UE (1988) Improving the outcome and efficiency of intensive care: The impact of an intensivist. Crit Care Med 16: 11–17PubMedCrossRefGoogle Scholar
  17. 17.
    Carson SS, Stocking C, Podsadecki T, et al (1996) Effects of organizational change in the medical intensive care unit of a teaching hospital. JAMA 276: 322–328PubMedCrossRefGoogle Scholar
  18. 18.
    Hanson III CW, Deutschman CS, Anderson III HL (1999) Effects of an organized critical care service on outcomes and resource utilization: a cohort study. Crit Care Med 27: 270274Google Scholar
  19. 19.
    Ghorra S, Reinert SE, Cioffi W, Buczko G, Simms HH (1999) Analysis of the effect of conversion from open to closed surgical intensive care unit. Ann Surg 229: 163–171PubMedCrossRefGoogle Scholar
  20. 20.
    Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288: 1987–1993PubMedCrossRefGoogle Scholar
  21. 21.
    Dimick JB, Swoboda SM, Pronovost PJ, Lipsett PA (2001) Effect of nurse-to-patient ratio in the intensive care unit on pulmonary complications and resource use after hepatectomy. Am J Crit Care 10: 376–382PubMedGoogle Scholar
  22. 22.
    Pronovost PJ, Dang D, Dorman T, et al (2001) Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery. Eff Clin Pract 4: 199–206PubMedGoogle Scholar
  23. 23.
    Amaravadi RK, Dimick JB, Pronovost PJ, Lipsett PA (2000) ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy. Intensive Care Med 26: 1857–1862PubMedCrossRefGoogle Scholar
  24. 24.
    Leape LL, Cullen DJ, Clapp MD, et al (1999) Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA 282: 267–270PubMedCrossRefGoogle Scholar
  25. 25.
    Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL (1998) Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg 228: 71–78PubMedCrossRefGoogle Scholar
  26. 26.
    Birkmeyer JD, Siewers AE, Finlayson EV, et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346: 1128–1137PubMedCrossRefGoogle Scholar
  27. 27.
    Begg, CB, Cramer LD, Hoskins WJ, Brennan MF (1998) Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280: 1747–1751PubMedCrossRefGoogle Scholar
  28. 28.
    Randolph AG, Pronovost P (2002) Reorganizing the delivery of intensive care could improve efficiency and save lives. J Eval Clin Pract 8: 1–8PubMedCrossRefGoogle Scholar
  29. 29.
    Pronovost P, Angus DC (1999) Using large-scale databases to measure outcomes in critical care. Crit Care Clin 15: 615–631PubMedCrossRefGoogle Scholar
  30. 30.
    Daley J, Henderson WG, Khuri SF (2001) Risk-adjusted surgical outcomes. Annu Rev Med 52: 275–287PubMedCrossRefGoogle Scholar
  31. 31.
    Birkmeyer JD (2000) Should we regionalize major surgery? Potential benefits and policy considerations. J Am Coll Surg 190: 341–349PubMedCrossRefGoogle Scholar
  32. 32.
    Halm EA, Lee C, Chassin MR (2002) Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 137: 511–520PubMedCrossRefGoogle Scholar
  33. 33.
    Institute of Medicine (2001) Interpreting the Volume-Outcome Relationship in the Context of Cancer Care. National Academy Press, WashingtonGoogle Scholar
  34. 34.
    Birkmeyer JD, Finlayson EV, Birkmeyer CM (2001) Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery 130: 415–422PubMedCrossRefGoogle Scholar
  35. 35.
    Cronenwett J, Birkmeyer J (2000) The Dartmouth Atlas of Vascular Health Care. AHA Press, ChicagoGoogle Scholar
  36. 36.
    Hillner BE, Smith TJ, Desch CE (2000) Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol 18: 2327–2340PubMedGoogle Scholar
  37. 37.
    Tu JV, Austin PC, Johnston KW (2001) The influence of surgical specialty training on the outcomes of elective abdominal aortic aneurysm surgery. J Vasc Surg 33: 447–452PubMedCrossRefGoogle Scholar
  38. 38.
    Hannan EL, Popp AJ, Feustel P, et al (2001) Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy. Stroke 32: 2890–2897PubMedCrossRefGoogle Scholar
  39. 39.
    Pronovost PJ, Angus DC, Dorman T, Robinson K, Dremsizov TT, Young TL (2002) Physician staffing patterns and clinical outcomes in critically ill patients: A systematic review. JAMA 288: 2151–2162PubMedCrossRefGoogle Scholar
  40. 40.
    Rosenfeld BA, Dorman T, Breslow MJ, et al (2000) Intensive care unit telemedicine: alternate paradigm for providing continuous intensivist care. Crit Care Med 28: 3925–3931PubMedCrossRefGoogle Scholar
  41. 41.
    Fridkin SK, Pear SM, Williamson TH, Galgiani JN, Jarvis WR (1996) The role of under-staffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 17: 150–158PubMedCrossRefGoogle Scholar
  42. 42.
    Blegen MA, Goode CJ, Reed L (1998) Nurse staffing and patient outcomes. Nurse Res 47: 43–50CrossRefGoogle Scholar
  43. 43.
    Archibald, LK, Manning ML, Bell LM, Banerjee S, Jarvis WR (1997) Patient density, nurseto-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 16: 1045–1048PubMedCrossRefGoogle Scholar
  44. 44.
    Aiken LH, Clarke SP, Sloane DM, Sochalski, J, Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288: 1987–1993PubMedCrossRefGoogle Scholar
  45. 45.
    Leape LL, Cullen DJ, Clapp MD, et al (199) Pharmacist participation on physician rouds and adverse drug events in the intensive care unit. JAMA 282: 267–270Google Scholar
  46. 46.
    Gandhi PJ, Smith BS, Tataronis GR, Maas B (2001) Impact of a pharmacist on drug costs in a coronary care unit. Am J Health Syst Pharm 58: 497–503PubMedGoogle Scholar
  47. 47.
    Krupicka MI, Bratton SL, Sonnenthal K, Goldstein B (2002) Impact of a pediatric clinical pharmacist in the pediatric intensive care unit. Crit Care Med 30: 919–921PubMedCrossRefGoogle Scholar
  48. 48.
    Young MP, Birkmeyer JD (2000) Potential reduction in mortality rates using an intensivist model to manage intensive care units. Eff Clin Pract 3: 284–289PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • J. B. Dimick
  • P. J. Pronovost
  • P. A. Lipsett

There are no affiliations available

Personalised recommendations