Surgical intensive care: Measures for quality control and an overview on current guidelines

Surgical intensive care focuses on the therapy of secondary organ failure resulting from surgical complications or massive surgical trauma. Consequently, therapeutic success depends on the simultaneous efficacy of surgical therapy and intensive care which, however, cannot compensate for surgical errors. Both aspects of care need to be addressed for quality control. Quality control in intensive care includes the analysis of cost-effectiveness and the use of scoring systems and evidence-based guidelines. Thus far, cost-effectiveness has only been determined in a general sense for a few procedures. An analytical concept which would allow an individual analysis of cost-effectiveness for a single institution is still missing. The reliability of scoring systems is mostly restricted to comparisons within individual institutions since corresponding scores cannot yet account adequately for differences in case mixes between different institutions. For evidence-based therapy in critically ill patients more than 80 guidelines are currently available. Guidelines have to be distinguished from directives and represent decisional aids which have been developed systematically and which have to be perceived as recommendations from which one may diverge in well-founded cases. Introduction of guidelines into clinical routine has significantly improved the prognosis of surgical critically ill patients in the last years.