As medicine has advanced over the past 50 years, the need for high-quality, cost-effective critical care services has expanded exponentially. In the USA, one recent estimate was that five million patients are admitted to intensive care units (ICUs) every year, leading to 23 million ICU bed days [1]. The cost of managing these patients typically accounts for a large percentage of hospital costs.


Critical care metrics ICU staffing Clinical management guidelines Quality improvement 


  1. 1.
    Halpern NA, Pastores SM, Oropello JM, et al. Critical care medicine in the United States: addressing the intensivist shortage and image of the specialty. Crit Care Med. 2013;41:2754–61.CrossRefPubMedCentralGoogle Scholar
  2. 2.
    Wilcox ME, Chong CAKY, Niven DJ, et al. Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med. 2013;41:2253–74.CrossRefGoogle Scholar
  3. 3.
    Wallace DJ, Angus DC, Barnato AE, et al. Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med. 2012;366:2093–101.CrossRefPubMedCentralGoogle Scholar
  4. 4.
    Kerlin MP, Small DS, Cooney E, et al. A randomized trial of nighttime physician staffing in an intensive care unit. N Engl J Med. 2013;368:2201–9.CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Weled BJ, Adzhigirey LA, Hodgman TM, et al. Critical care delivery: the importance of process of care and ICU structure to improved outcomes. An update from the American College of Critical Care Medicine Task Force on Models of Critical Care. Crit Care Med. 2015;43(7):1520–5.CrossRefPubMedCentralGoogle Scholar
  6. 6.
    Bing-Hua YU. Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality. Am J Surg. 2014;208:268–74.CrossRefPubMedCentralGoogle Scholar
  7. 7.
    Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med. 2011;365:139–46.CrossRefPubMedCentralGoogle Scholar
  8. 8.
    Lilly CM, Zubrow MT, Kempner KM, et al. Critical care telemedicine: evolution and state of the art. Crit Care Med. 2014;42:2429–36.CrossRefPubMedCentralGoogle Scholar
  9. 9.
  10. 10.
    Ward NS, Afessa B, Kleinpell R, et al. Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing. Crit Care Med. 2013;41:638–45.CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Donabedian A. Continuity and change in the quest for quality. Clin Perform Qual Health Care. 1993;1:9–16.Google Scholar
  12. 12.
    Curtis JR, Cook DJ, Wall RJ, et al. Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med. 2006;34:211–8.CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Byrnes MC, Schuerer DJ, Schallom ME, et al. Implementation of a mandatory checklist of protocols and objectives improves compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med. 2009;37:2775–81.CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Gurses AP, Murphy DJ, Martinez EA, et al. A practical tool to identify and eliminate barriers to compliance with evidence-based guidelines. Jt Comm J Qual Patient Saf. 2009;35:526–32. 485.CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Penkoske PA, Buchman TG. The relationship between the surgeon and the intensivist in the surgical intensive care unit. Surg Clin N Am. 2006;86:1351–7.CrossRefPubMedCentralGoogle Scholar
  16. 16.
    St Andre A. The formation, elements of success, and challenges in managing a critical care program (Part I). Crit Care Med. 2015;43(4):874–9.CrossRefPubMedCentralGoogle Scholar
  17. 17.
    St Andre A. The formation, elements of success, and challenges in managing a critical care program (Part II). Crit Care Med. 2015;43(5):1096–101.CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Open Access This chapter is distributed under the terms of the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

Authors and Affiliations

  1. 1.Surgical Intensive Care Unit, RA Cowley Shock Trauma CenterUniversity of Maryland Medical CenterBaltimoreUSA

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