Results of a collaborative quality improvement program on outcomes and costs in a tertiary critical care unit

Objective: To demonstrate that by using the knowledge and skills of the pri mary care provider and by applying statistical and scientific principles of quality improvement, outcomes can be improved and costs significantly redu ced. Design: A before and after quasi-experimentally designed trial using histor ical controls plus an analysis of costs in areas not influenced by intensiv e care unit (ICU) practice to control for possible secular changes. Setting: A tertiary ICU. Patients: Ail patients admitted to the above-mentioned ICU from January 1, 1991, through December 31, 1995. Interventions: a) A focused program that applied statistical and scientific quality improvement processes to the practice of intensive care. b) An org anized effort to modify the culture, thinking, and behavior of the personne l who practice in the ICU. Measurements: Severity of illness, ICU and hospital lengths of stay, ICU an d hospital mortality rates, total hospital costs as analyzed by the cost ce nter, and measures of improvement in specific areas of care. Main Results: Significant improvement in glucose control, use of enteral fe eding, antibiotic use, adult respiratory distress syndrome survival, labora tory use, blood gases use, radiograph use, and appropriate use of sedation. A severity adjusted total hospital cost reduction of $2,580,981 in 1991 do llars when comparing 1995 with the control year of 1991, with 87% of the re duction in those cost centers directly influenced by the intervention. Conclusions: A focused quality improvement program in the ICU can have a be neficial impact on care and simultaneously reduce costs.