http://www.ijccm.org/currentissue.asp Indian J Crit Care Med 2008 - 12(2) Indian Journal of Critical Care Medicine Medknow Publications0972-5229 Raja Jayaram N Ramakrishnan Review Article Indian Journal of Critical Care Medicine 2008 12(2):55-61doi:10.4103/0972-5229.42558 Indian Journal of Critical Care Medicine 10.4103/0972-5229.42558 http://www.ijccm.org/text.asp?2008/12/2/55/42558 http://www.ijccm.org/text.asp?2008/12/2/55/42558122 55 61 http://www.ijccm.org/text.asp?2008/12/2/55/42558 Raja Jayaram, N Ramakrishnan

Indian Journal of Critical Care Medicine 2008 12(2):55-61

Critical care is often described as expensive care. However, standardized methodology that would enable determination and international comparisons of cost is currently lacking. This article attempts to review this important issue and develop a framework through which cost of critical care in India could be analyzed.]]> Tue,19 Aug 2008http://www.ijccm.org/text.asp?2008/12/2/55/42558 Julian Bion Review Article Indian Journal of Critical Care Medicine 2008 12(2):62-66doi:10.4103/0972-5229.42559 Indian Journal of Critical Care Medicine 10.4103/0972-5229.42559 http://www.ijccm.org/text.asp?2008/12/2/62/42559 http://www.ijccm.org/text.asp?2008/12/2/62/42559122 62 66 http://www.ijccm.org/text.asp?2008/12/2/62/42559 Julian Bion

Indian Journal of Critical Care Medicine 2008 12(2):62-66

Patient safety has become a major defining issue for healthcare at the beginning of the 21 st century. Viewed from the perspective of reliability of delivery of best practice, healthcare systems demonstrate a degree of imperfection which would not be tolerated in industry. In part, this is because of uncertainty about what constitutes best practice, combined with complex interventions in complex systems. The acutely ill patient is particularly challenging, and as the majority of admissions to hospitals are emergencies, it makes sense to focus on this group as a coherent entity. Changing clinical behavior is central to improving safety, and this requires a systems-wide approach integrating care throughout patient journey, combined with incorporating reliability training in life-long learning.]]> Tue,19 Aug 2008http://www.ijccm.org/text.asp?2008/12/2/62/42559 Lakshmi P Chelluri Review Article Indian Journal of Critical Care Medicine 2008 12(2):67-76doi:10.4103/0972-5229.42560 Indian Journal of Critical Care Medicine 10.4103/0972-5229.42560 http://www.ijccm.org/text.asp?2008/12/2/67/42560 http://www.ijccm.org/text.asp?2008/12/2/67/42560122 67 76 http://www.ijccm.org/text.asp?2008/12/2/67/42560 Lakshmi P Chelluri

Indian Journal of Critical Care Medicine 2008 12(2):67-76

In the past decade, there is an increased focus on quality and safety in health care. Decreasing variation, increasing adherence to evidence based guidelines, monitoring processes, and measuring outcomes are critical for improving quality of care. Intensivists have broad knowledge of hospital organization, and need to be leaders in quality improvement efforts.]]> Tue,19 Aug 2008http://www.ijccm.org/text.asp?2008/12/2/67/42560 Ken Hillman Review Article Indian Journal of Critical Care Medicine 2008 12(2):77-81doi:10.4103/0972-5229.42561 Indian Journal of Critical Care Medicine 10.4103/0972-5229.42561 http://www.ijccm.org/text.asp?2008/12/2/77/42561 http://www.ijccm.org/text.asp?2008/12/2/77/42561122 77 81 http://www.ijccm.org/text.asp?2008/12/2/77/42561 Ken Hillman

Indian Journal of Critical Care Medicine 2008 12(2):77-81

Intensive care medicine was for many years practiced within the four walls of an intensive care unit (ICU). Evidence then emerged that many serious adverse events in hospitals were preceded by many hours of slow deterioration, resulting in multi-organ failure and potentially preventable admissions to the ICU. Ironically, these admissions may have been prevented if the skills within the ICU had been available to the patient on the general ward at an earlier stage. The concept of a Medical Emergency Team (MET) was developed to enable staff from the ICU to rapidly identify and respond to serious illness at an earlier stage and, hopefully, prevent serious complications. Since then, other forms of rapid response and outreach systems have been developed. Increasingly, physicians working in ICUs can see the benefit of the early management of serious illness in order to improve patient outcome.]]> Tue,19 Aug 2008http://www.ijccm.org/text.asp?2008/12/2/77/42561 Elisabeth L George Patricia Tuite Original Article Indian Journal of Critical Care Medicine 2008 12(2):82-87doi:10.4103/0972-5229.42562 Indian Journal of Critical Care Medicine 10.4103/0972-5229.42562 http://www.ijccm.org/text.asp?2008/12/2/82/42562 http://www.ijccm.org/text.asp?2008/12/2/82/42562122 82 87 http://www.ijccm.org/text.asp?2008/12/2/82/42562 Elisabeth L George, Patricia Tuite

Indian Journal of Critical Care Medicine 2008 12(2):82-87

Goals of health care are patient safety and quality patient outcomes. Evidence based practice (EBP) is viewed as a tool to achieve these goals. Health care providers strive to base practice on evidence, but the literature identifies numerous challenges to implementing and sustaining EBP in nursing. An initial focus is developing an organizational culture that supports the process for nursing and EBP. An innovative strategy to promote a culture of EBP was implemented in a tertiary center with 152 critical care beds and numerous specialty units with diverse patient populations. A multi-disciplinary committee was developed with the goal to use evidence to improve the care in the critical care population. EBP projects were identified from a literature review. This innovative approach resulted in improved patient outcomes and also provided a method to educate staff on EBP. The committee members have become advocates for EBP and serve as innovators for change to incorporate evidence into decision making for patient care on their units.]]> Tue,19 Aug 2008http://www.ijccm.org/text.asp?2008/12/2/82/42562