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Crit Care Med. 2015 Jul;43(7):1520-5. doi: 10.1097/CCM.0000000000000978.

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.

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1CHI Franciscan Health, Tacoma, WA. 2Northwest Community Hospital, Arlington Heights, IL. 3Nationwide Children's Hospital, Columbus, OH. 4Cooper University Hospital, Oxford, PA. 5Rush University, Northville, MI. 6University of Louisville, Louisville, KY. 7INOVA Fairfax Hospital, Arlington, VA. 8University of Pittsburgh Medical Center, Pittsburgh, PA. 9UCLA Health Sciences Center, Los Angeles, CA. 10The Armstrong Institute, Johns Hopkins School of Medicine, Baltimore, MD. 11CriticalMed, Inc., Bethesda, MD. 12Stanford University, Stanford, CA. 13Cincinnati Children's Hospital Medical Center, Cincinnati, OH.


In 2001, the Society of Critical Care Medicine published practice model guidelines that focused on the delivery of critical care and the roles of different ICU team members. An exhaustive review of the additional literature published since the last guideline has demonstrated that both the structure and process of care in the ICU are important for achieving optimal patient outcomes. Since the publication of the original guideline, several authorities have recognized that improvements in the processes of care, ICU structure, and the use of quality improvement science methodologies can beneficially impact patient outcomes and reduce costs. Herein, we summarize findings of the American College of Critical Care Medicine Task Force on Models of Critical Care: 1) An intensivist-led, high-performing, multidisciplinary team dedicated to the ICU is an integral part of effective care delivery; 2) Process improvement is the backbone of achieving high-quality ICU outcomes; 3) Standardized protocols including care bundles and order sets to facilitate measurable processes and outcomes should be used and further developed in the ICU setting; and 4) Institutional support for comprehensive quality improvement programs as well as tele-ICU programs should be provided.

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