Quality Improvement and Neurocritical Care

Abstract

In 1998 the Institute of Medicine established the Committee on the Quality of Healthcare in America in response to growing concern over the quality, safety, efficacy, and efficiency of healthcare in the USA. The primary motivation behind this committee was the belief that despite technological and scientific advances, very small gains had been made in quality of care and patient outcome. Quality improvement is the process by which we critically evaluate care provided by a practitioner in the context of the health system in which they work and enact changes in processes that moves us toward the goal of providing care that is patient and family centered, reproducible, safe, and evidence based; where there are no or inadequate data upon which to base care decisions, quality improvement encourages discovery to generate such information. Additionally, the emphasis on quality in medicine is intimately related to cost-effectiveness and cost reduction. There are a number of ICU-specific quality measures being reported to the UHC, CMS, and other reporting agencies. These measures include development of practices to prevent hospital-acquired conditions and have an emphasis on patient safety. In addition to these specific measures, other factors impact quality of care in a modern ICU, including team communication skills and effective information handoff. Communication is a critically important skill in the NeuroICU, linking physicians, advanced practitioners, nurses, respiratory therapists, physical and occupational therapists, clerks, pharmacists, dietitians, and most importantly, the patient and their family. We expect the role of quality improvement to grow over the next decade, and it will make a significant impact on how we practice medicine in the future.