Ensuring quality in intensive care: the Swiss situation

The movement for quality in medicine is starting to take on the dimensions of a crusade. Quite logically it has also reached the intensive care commun ity. Due to their complex multidisciplinary functioning and because of the high costs involved, ICUs are model services reflecting the overall situati on in our hospitals. The situation of Swiss intensive care is particularly interesting, because for over 25 years standards for design and staffing of Swiss ICUs have been in effect and were enforced via onsite visits by the Swiss Society of Intensive Care without government involvement. Swiss inten sive care thus defined its structures long before the word "accreditation" had even been used in this context. While intensive care in Switzerland is practised in clearly defined, well e quipped and adequately staffed units, much less is known about process qual ity and outcomes of these services. Statistics on admissions, length of sta y and length of mechanical ventilation, as well as severity data based on a simple classification system, are collected nationwide and allow some limi ted insight into the overall process of care. Results of intensive care are not systematically assessed. In response to the constant threat of cost co ntainment, Swiss ICUs should increasingly focus on process quality and resu lts, while maintaining their existing good structures.