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January 26, 2011

Improving the Science and Politics of Quality Improvement

Author Affiliations

Author Affiliations: Division of Pulmonary and Critical Care Medicine, Harborview Medical Center and University of Washington, Seattle (Dr Curtis); and Division of Pulmonary, Critical Care, and Sleep, Warren Albert Medical School at Brown University, Rhode Island Hospital, Providence (Dr Levy).

JAMA. 2011;305(4):406-407. doi:10.1001/jama.2011.8

Quality and safety are critical issues for health care systems around the world and have appropriately been highlighted in ongoing efforts to reform and improve health care. Care of critically ill patients is a domain in which issues of quality and safety take on monumental importance because of the severity of illness and the complexity of providing high-quality critical care.

In this issue of JAMA, Scales and colleagues1 report the results of an important study designed to evaluate the effectiveness of quality improvement efforts in community-based critical care units in Ontario. The authors use a multifaceted “knowledge transfer” intervention including education, dissemination of algorithms, and audit and feedback, transferred through an interactive telecommunication strategy. The goal of the intervention was to increase adherence to 6 quality measures that have been documented to improve patient outcomes: prevention of ventilator-associated pneumonia (VAP), prophylaxis for deep venous thrombosis (DVT), daily spontaneous breathing trials, prevention of catheter-related bloodstream infections, early enteral feeding, and prevention of decubitus ulcers. Although debate remains about some of the evidence supporting these measures, there is general consensus that appropriate implementation of each measure can decrease risk of harm for critically ill patients.

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