ECMO-/ECLS

III. Quality Improvement in Critical Care
Despite high levels of evidence or established guidelines with recommendations
for “best practices”, adoption of specific treatments that lead to improved outcomes in
patients are difficult to obtain using traditional physician level implementation [ 33 , 34 ].
As an example, hand hygiene has been documented to decrease hospita- acquired
infections and the Center for Disease Control has published evidenced-based
guidelines for hand hygiene [ 33 , 35 ]. Despite institutions providing the necessary
products and supplies for compliance and high levels of staff member awareness of
these guidelines, Larson et al demonstrated that hand hygiene compliance was only
56% across 40 member hospitals of the National Nosocomial Infection Surveillance
System [ 33 ]. Alarmingly, this rate is similar to rates of hand hygiene compliance
reported for the past few decades prior to the guidelines. The combination of an
increasingly complex patient population, an exponentially increasing medical literature,
and variations in physician awareness and interpretation of the available information
lead to wide variations in care and adoption of beneficial treatments for our patients.
The quality improvement (QI) process aims to improve care by adopting practice-based
approaches to care that can reduce variation and make it easy to apply “best practices”
during the treatment of our patients [ 36 ]. The principles, processes, and practice of QI
science applied to critical care represent ordinary opportunities to use existing
knowledge to create extraordinary improvements in the care and outcomes of our
patients.
QI represents the science of process management with a learning based
approach to understand and then improve the process. In medical care, this translates