Enhancing the Quality of Care in the Intensive Care Unit: A Systems Engineering Approach

doi:10.1016/j.ccc.2012.10.009

Critical Care Clinics

Volume 29, Issue 1, January 2013, Pages 113-124

https://doi.org/10.1016/j.ccc.2012.10.009 Get rights and content

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Key points

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Health care systems must embrace a more formal process to deal with rising costs, complexity, and patient harms.
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Systems engineering methodologies have been applied successfully to solve other major industrial problems.
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The systems engineering process reproducibly formalizes defining system problems and goals and prioritizes development of a system to meet those goals.
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The Patient Care Program Acute Care Initiative project will use a holistic patient-centered systems engineering approach to

Overview of SE methodology

The origins of SE are not clear, but its core principles, or systems methodology, emerged to help manage the rapid growth of many complex systems. The International Council of Systems Engineering (INCOSE) describes the history of the field and offers this comprehensive definition of a system as

…a construct or collections of different elements that together produce results not obtainable by the elements alone. The elements, or parts, can include people, hardware, software, facilities, policies,

Application of SE methodology

The PCPACI set out to enhance the quality of care and reduce patient harms in the ICU by using SE methodology. The following sections provide examples of how the PCPACI has used and will continue to use SE methodology. For brevity and consistency, examples focus on ICU-acquired weakness and early mobilization subsystems.

Summary

Our rapidly expanding and fragmented health care systems are unsustainable. Our health care system too often harms patients, is too costly, and too often relies on the heroism of clinicians rather than good system design. Recent analyses from the Institute of Medicine suggest that about one-third of health care spending, or $750 billion, is wasted on inefficiencies and does nothing to make patients better.³ New financial pressures and government policies will force changes in the health care

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References (10)

E.E. Vasilevskis et al.
Reducing iatrogenic risks: ICU-acquired delirium and weakness–crossing the quality chasm
Chest
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P.J. Pronovost et al.
Preventing patient harms through systems of care
JAMA
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S.C. Mathews et al.
The need for systems integration in health care
JAMA
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Institute of Medicine
Best care at lower cost: the path to continuously learning health care in America
(2012)
Health and human services, partnership for patients: making care safer. 2012. Available at:...

There are more references available in the full text version of this article.

Cited by (16)

Systems thinking in the operating room
2023, Handbook of Perioperative and Procedural Patient Safety
An operating room represents a highly complex system involving people (i.e., surgeons, nurses, anesthesiologists, patients), hardware (i.e., mechanical ventilator, monitors, surveillance equipment, computers), software, interfaces (i.e., screens, cameras, keyboards, microphones), and processes (i.e., checklists, policies) that are interrelated and share a set of common objectives. Deficiencies in performance, whether related directly to patient outcomes or due to inefficiencies in operating room workflow, require a holistic approach to designing and implementing system solutions. Systems Engineering and the Systems Approach provide a context and framework for the prospective design and implementation of complex systems. This chapter provides the background and rationale for applying Systems Engineering to healthcare as well as introduces the basic framework for utilizing the System Development Lifecycle to solve complex problems in the operating room environment.
Safety culture in intensive care internationally and in Australia: A narrative review of the literature
2019, Australian Critical Care
Citation Excerpt :
Much of the initial SC research in the healthcare domain was conducted in intensive care units (ICUs).18,19 Intensive care is a highly complex organisational unit with significant variability in patient admission diagnoses and a narrow margin for error, making it a uniquely high-risk healthcare environment.20–22 Critical care nurses are a large proportion of the intensive care multidisciplinary workforce, and thus, SC would be considered a pivotal part of their role.
Assessment of safety culture in health care is of particular relevance in the complex intensive care setting, where the effects of human error can have catastrophic consequences. The aim of this review was to examine the literature on safety culture in intensive care units (ICUs) and specifically, to explore the state of knowledge regarding safety culture in the context of Australian ICUs.
A search was conducted of key databases for studies published in English between January 2008 and December 2017 using terms ‘safety culture’, ‘safety climate’, ‘safety attitude’, ‘intensive care’, ‘ICU’ and ‘critical care’. Studies were included if they presented original research, utilised the teamwork and safety climate factors of a quantitative survey tool to assess safety culture, the sample population included participants working in an adult intensive care, and the findings were reported in the context of intensive care.
Of the 36 studies identified, two were conducted in Australia. The studies demonstrate a rapid expansion in safety culture assessment globally. Three levels of safety culture application in intensive care were identified, including safety culture assessment, effect of an intervention on safety culture, and evaluation of the association between safety culture and structural, process and outcomes measures. The use of targeted safety culture domains is emerging. Common findings included variation in perceptions of safety culture between ICUs, unit and hospital management, and professional groups.
Though the assessment of safety culture in ICUs has been an area of prolific research internationally over the past ten years, the Australian context is limited and could be advanced through further research, including the effect on safety culture of interventions, and to establish the association between safety culture and patient safety outcomes. Longitudinal studies to demonstrate sustained intervention effects on safety culture should be considered.
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: An ongoing assessment
2021, Journal of Patient Safety
Prioritizing Health Care Solutions for Pressure Ulcers Using the Quality Function Deployment Process
2020, American Journal of Medical Quality
Intensive care unit providers more quickly and accurately assess risk of multiple harms using an engineered safety display
2019, Health Informatics Journal
Making Smarter Decisions Faster: Systems Engineering to Improve the Global Public Health Response to HIV
2019, Current HIV/AIDS Reports

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: Funding sources: This work has been funded by The Gordon and Betty Moore Foundation and The Systems Institute of Johns Hopkins University. Additional support includes: Mr Ravitz: Agency for Healthcare Research and Quality Grant 1R18HS020460; Dr Romig: Department of Anesthesiology & Critical Care Medicine; Dr Pronovost: none; Dr Sapirstein: Department of Anesthesiology & Critical Care Medicine.

: Conflict of interest: Dr Tropello, Mr Ravitz, Dr Romig, and Dr Sapirstein have no conflicts to report. Dr Pronovost has received funding from the Agency for Healthcare Research and Quality, the National Institutes of Health, RAND, and the Commonwealth Fund for research related to measuring and improving patient safety; honoraria from various hospitals and health care systems and the Leigh Bureau to speak on quality and safety; consultancy with the Association for Professionals in Infection Control and Epidemiology, and book royalties for Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care From the Inside Out.

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Enhancing the Quality of Care in the Intensive Care Unit: A Systems Engineering Approach

Section snippets

Key points

Overview of SE methodology

Application of SE methodology

Summary

First page preview

Chest

Preventing patient harms through systems of care

JAMA

The need for systems integration in health care

JAMA

Best care at lower cost: the path to continuously learning health care in America