tailieunhanh - Báo cáo y học: " ICU staffing and patient outcomes: more work remain"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: ICU staffing and patient outcomes: more work remains. | Available online http content 13 1 101 Commentary ICU staffing and patient outcomes more work remains David J Murphy Eddy Fan and Dale M Needham Pulmonary and Critical Care Medicine Johns Hopkins Medical Institutions 1830 E. Monument Street Baltimore MD 21205 USA Corresponding author Dale M Needham Published 7 January 2009 This article is online at http content 13 1 101 2009 BioMed Central Ltd Critical Care 2009 13 101 doi cc7113 See related research by Cooke et al. http content 12 6 R134 Abstract Many studies have demonstrated that closed intensive care units ICUs staffed by trained intensivists are associated with improved patient outcomes. However the mechanisms by which ICU organizational factors such as physician staffing influence patient outcomes are unclear. One potential mechanism is the increased utilization of evidence-based practices in closed ICUs. Cooke and colleagues investigated this hypothesis in a cohort of 759 acute lung injury patients in 23 ICUs in King County Washington USA. Although closed ICUs were independently associated with a modestly lower mean tidal volume this finding did not explain the mortality benefit associated with a closed ICU model in this patient cohort. Future studies should evaluate other potential mechanisms by which closed ICUs improve patient outcomes. An improved understanding of these mechanisms may yield new targets for improving the quality of medical care for all ICU patients. The mechanisms by which closed intensive care units ICUs defined as units in which patient care is directed by board certified intensivists improve patient outcomes are unclear. Increased use of low tidal volume ventilation LTVV has been hypothesized as a mechanism underlying the lower hospital mortality observed in acute lung injury ALI patients treated in closed ICUs. To investigate this issue Cooke and colleagues 1 assessed the effect of a closed ICU physician staffing model