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Intensive care at two teaching hospitals: an organizational case study
J E Zimmerman1, D M Rousseau, J Duffy
1Department of Anesthesiology, George Washington University Medical Center, Washington, DC 20037.
Summary
Organizational analysis of two intensive care units (ICUs) revealed no clear differences in structure or organization despite varying survival rates. Both ICUs had areas for improvement and best practices to share for better ICU management.
Area of Science:
- Critical Care Medicine
- Health Services Research
- Organizational Behavior
Background:
- Intensive Care Units (ICUs) are critical care settings where structural and organizational factors may influence patient outcomes.
- Significant variations in risk-adjusted survival exist between ICUs, prompting an investigation into underlying causes.
Purpose of the Study:
- To investigate the structural and organizational characteristics of two ICUs with notably different risk-adjusted survival rates.
- To identify potential factors contributing to variations in ICU performance.
Main Methods:
- On-site organizational analysis was conducted in two major teaching hospital ICUs.
- Data collection included interviews, direct observations, analysis of 888 ICU admissions' demographic, clinical, and survival data, and staff questionnaires.
- ICU performance was assessed using risk-adjusted survival and length of stay/resource use ratios.
Main Results:
- Standard questionnaires, staff self-evaluations, and researcher judgments did not differentiate between ICUs with higher and lower risk-adjusted survival.
- Both analyzed ICUs demonstrated a mix of exemplary practices and areas needing improvement.
Conclusions:
- The employed methodologies effectively identified organizational issues and potential improvement strategies within ICUs.
- The study provides examples of best practices and improvement suggestions applicable to enhancing ICU management and performance.