Critical Care Administration: A Comprehensive Clinical Guide

Foreword
Preface
Acknowledgments
Contents
Contributors
Chapter 1: Critical Care Services: Scope of Practice
	Introduction
	ICU Organizational Models
	Definitions
	Clinical Outcomes Associated with Different ICU Organizational Models
	Outcomes Related to 24/7 and Night Coverage by ICU Physicians
	General and Specialized ICUs
	Critical Care Services Outside the ICU
	Summary
	ICU Rounds
	The Composition of the Multidisciplinary Team
	The Structure and Organization of ICU Rounds
	Summary
	Conclusion
	References
Chapter 2: Planning and Budgeting
	Introduction
	Strategic Planning
		A Strategic Assessment
		Formulating Objectives
		Making Strategic Choices
	Budgeting
	The Budgeting Context for Intensive Care
	Characteristics of Intensive Care Budgeting
	Types of Budgets
		Revenue
		Operating Expenses
		Case Mix Index (CMI)
			Intensive Care Costing Methodology and Efficiency
	Population Mix/Payers Mix
	Understanding the Need for Intensive Care Beds
	Outcomes with Intensive Care
	Decreasing the Cost of Care
	Return on Investment
	Tele-ICU as a Key Element of Achieving ROI
	Cost-Effectiveness Analysis
	Training for Staff, Fellows, and Residents
	Fellowship Training Requirements
	Interprofessional Education (IPE) Approach
	Professional Development Program
	References
Chapter 3: Setting the Goals
	Introduction
	Medical Staff Needs
		The ICU: What Type of Unit and Who Staffs It?
		Staffing (Continued) and Organization
		Outreach Services
	Institutional Needs
	References
Chapter 4: Administration Support
	Introduction
	ICU Models of Care
		Functional Considerations
		Staffing Considerations
		24-Hour Intensivist Staffing
		Other Considerations
	Critical Care Transport
	The ICU as a High Reliability Organization
	Conclusion
	References
Chapter 5: Quality Indicators: The Use of Metrics in Critical Care Medicine
	Value in Healthcare
	Framework for Assessing Quality
	Essential Attributes of Quality Metrics
	Setting Your Quality Program Up for Success
	Examples of Quality Metrics in Critical Care
	Potential Pitfalls to Avoid
	Conclusions
	References
Chapter 6: Internal Financial Audits in the ICU
	Introduction and Overview
	The Internal ICU Financial Audit
	Summary
	References
		Additional Reading
Chapter 7: Models of Staffing
	Overview
	Intensivist Staffing
	ICU Organization
	Critical Care Society Recommendations
	Nurse Staffing
	Nurse Practitioners and Physician Assistants
	Resident/Fellow Supervision
	Hospitalists
	Telemedicine
	Summary
	References
Chapter 8: Tele-ICU
	Introduction
	Models of Tele-ICU
		Centralized Model
		Decentralized Model
		Hybrid Model
		Staffing for Tele-ICU
		Financial Considerations
		Barriers to Implementation
	Outcomes from Utilization of Tele-ICU
		Provider-Centered Outcomes
		Patient-Centered Outcomes
		System-Centered Outcomes
	Conclusion
	References
Chapter 9: Digital Transformation: The Smart ICU
	The Cultural Factor
	The Elements of the Digital Transformation
	Benefits of the Digital Transformation
		Improving Patient Care
		Facilitating Administrative Workload
		Resource Utilization
		Expansion of Knowledge
		Communication
	Telemedicine: Tele-ICU
	Smart ICU
		The “Techno” Problem
		Systems’ Interoperability
		Why Do We Need Smart ICU?
		The Components of Smart ICU
	Artificial Intelligence (AI)
	Conclusions
	References
Chapter 10: Protocols, Policies, and Procedures: Tools for Quality Improvement in Critical Care
	Introduction
	Tools to Implement ICU Policies and Procedures
	Overview of Policy Development and Establishing a Quality Improvement Committee and Programme
	Implementation of Policies
	Measurement of Performance
	Compliance with Physician Reporting
	Conclusion
	References
Chapter 11: ICU Design
	The Patient Room
	The Corridor Outside of Patient Rooms
	Unit Configuration
	Non-clinical Space
	Final Thoughts on ICU Design
	References
Chapter 12: Disaster Preparedness and Management
	Disaster Fundamentals
	Staff and Leadership Preparation
		Preparation for Care
		Preparation for Supervision
		Preparation for Leadership
	Planning
		All-Hazard Approach
		Key Local Events Including Weather
		Physical Plant Considerations
		Charting and Documentation
		Communication
		Water, Linens, Food, and Supply Chain Maintenance
		Evacuation
		Access
		Service Animals
		Drills and Location
		Partners
	Legal and Administrative Support
		Legal
		Administrative
		Roles Outside of the Institution
	Conclusion
	References
Chapter 13: Critical Care Educational Modeling
	Staff Education in the Modern Training Environment (Learner-Centered Model)
		Learners
		Educational Modalities
	Competency-Based Training
	Compassionate Coaching
	Workplace-Based Assessment
	Patient and Caregiver Education (Family-Centered Model)
		Learners
		Educational Modalities
	Competencies
	Simulation Training
		Learners
		Outline
	Teaching at the Bedside and During ICU Rounds
	Summary
	References
Chapter 14: Humanizing Critical Care
	What Is Humanization of the Intensive Care Units?
		People Are at the Center of Humanization
		Different Views of Humanization
	Care Provider Skill Set
	Scope of Humanization
	Talk to Me
	What Are We Waiting For?
	The Integration of Intensive and Palliative Care
	References
Chapter 15: Billing and Coding
	Introduction
	Disease-Related Group
	Critical Care Services
	Critical Care Time
	Shared Time-Split Time
	Teaching Time
	Nonphysician Practitioner (NPP) Billing
	Incident to Billing
	Direct Billing
	Split/Shared Billing
	Conclusions
	References
Chapter 16: Intensive Care Burnout
	History
	Definition and Measurement
	Prevalence
	Risk Factors
	Consequences
	Solutions
	Conclusion
	References
Chapter 17: Complementary Therapies
	Introduction and Definitions
	Prevalence
	Nurses and CAT
	CAT in the ICU
	Evidence-Based Support for CM
	Educational Programs
	Consequences
	Conclusions
	References
Chapter 18: Establishing a Research Program in the ICU
	Introduction
	Types of Research Programs
		Research in the Community Setting
		Collaborative Research
		Identifying Opportunities for Research
		The Business Plan for Research
	The Research Team
		The Investigator
		The Research Coordinator
		Other Team Members
		Role of the Program Manager
	Study Execution in an ICU
		Protocol Submission
		Screening and Enrollment
		Publication
	Ethical Considerations
		Attending and Enrolling Simultaneously
		Co-enrollment
		Enrollment of Patients at High Risk of Death
		The Institutional Review Board (IRB)
		Informed Consent
	Metrics for a Research Program
		Improving Patient Outcomes
		Supporting Future Opportunities
	Summary
	References
Chapter 19: The Safety of Patients in Critical Care
	Introduction
	Patient Safety: Definitions
	The Genesis of Incidents and Adverse Events
	Patient Safety in Critical Care Services
	Safety Practices
	Notifying Patients and Relatives of an Incident Related to Patient Safety (IRPS)
	Legal Aspects
	Support for Professionals Involved in an Adverse Event
	References
Index