ECMO-/ECLS

Chapter 20

A PRIMER ON CLINICAL RESEARCH AND QUALITY IMPROVEMENT

IN CRITICAL CARE

Peter Minneci, MD

i. Introduction
Ideally, there would be clinical evidence to use to determine which therapies
should be administered to each of our patients. Unfortunately, this type of evidence is
not readily available for many of the treatments that we use on a daily basis in our ICUs,
and when evidence is available, oftentimes it is not generalizable to the patient you are
actively treating. In order to deliver the best care possible for our patients, we must be
able to review the available literature that exists about the diseases and treatments that
we encounter and use in our ICUs; this requires an awareness of the various types of
clinical research and how to interpret them. In addition, quality improvement (QI)
science is increasingly being used to improve outcomes in critical care. QI programs are
now pervasive in many hospitals and intensive care units and it is important that the
practicing intensivist understand the basic fundamental principles of the QI process. The
following chapter will provide a brief overview of the various types of clinical research
and the techniques and tools of QI.

II. Clinical Research in Critical Care
Broadly defined, clinical research is an investigation that looks at a disease
process and reports characteristics about the disease process or outcomes from the
disease; outcomes research focuses on studying medical or surgical outcomes from a
disease process; and comparative effectiveness research (CER) compares specific