Enhancing the Quality of Care in the ICU

Preface Enhancing the Quality of C a r e i n t h e In t e n s i v e C a r e Unit

Robert C. Hyzy, MD Guest Editor

At some point everyone working in the area of quality improvement in medicine cites “To Err is Human” as the seminal moment when the medical field decided to focus its attention on decreasing medical errors and enhancing the quality of care delivered. Yet, medicine faces unique challenges which are unlike those of other “industries” whose efforts in the area of error reduction and quality improvement antedated those of medicine. The Six Sigma airline industry analogy, while worthy, is insufficient in that it fails to recognize the critical element of practice culture in determining outcomes. Put more simply, it is not a just about the checklist. As Heraclitus said, “no man steps in the same river twice.” However, this should never serve to rationalize poor practice culture, frequently justified as “my patients are different.” No successful study in the intensive care unit (ICU) can improve the quality of care delivered to patients without some ability to regulate interpersonal interactions. Subsequently, the ability to translate these behavioral changes to the bedside as a part of routine care on a daily basis becomes the real challenge, be it compliance with lung protective ventilation, sedation holidays, discontinuing central lines or urinary catheters, and so on. The success of the Michigan Keystone ICU collaborative is owed to the many nursing and physician leaders who served to champion the behavioral changes required to change the process of care in their ICUs. Change is not only possible, it is sustainable. Medicine has progressed to a different epoch of care from when the Institute of Medicine published “To Err is Human.” ICU quality has moved forward, sometimes fitfully (tight glycemic control), at other times forcefully (early mobility), but forward nevertheless. When asked by the editors of Critical Care Clinics if I would be willing to edit an edition on improving the quality of care in the ICU, I greedily accepted. It has been a privilege to interact and become friends with many of the most outstanding investigators working in the ICU to move our practice forward. I was honored they accepted my invitation to
Crit Care Clin 29 (2013) ix–x http://dx.doi.org/10.1016/j.ccc.2012.11.001 0749-0704/13/$ – see front matter Ó 2013 Published by Elsevier Inc.


MD University of Michigan 3916 Taubman Center Ann Arbor. I believe this collection offers the reader a thorough and concise primer on where we are in ICU quality improvement and where we are headed.x Preface make a contribution. Robert C. MI 48109. Hyzy.edu . USA E-mail address: rhyzy@umich.

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