Definitions from the Society of Critical Care Medicine Web Site

Adverse event: An adverse event is any incident that leads to patient harm.

Appropriately qualified physician: Physicians considered to be certified in Critical Care Medicine. They are:

• Physicians who completed training prior to the availability of subspecialty certifications in critical care in their specialty (1987 for Medicine, Anesthesiology, Pediatrics and Surgery), who are board-certified in one of these four specialties, and who have provided at least six weeks of full-time ICU care annually since 1987. (The weeks need not be consecutive weeks.)
• Physicians board certified in Medicine, Anesthesiology, Pediatrics or Surgery who have completed training programs required for certification in the subspecialty of Critical Care Medicine but are not yet certified in this specialty

Critical care: The medical care provided to people with an immediate life-threatening illness or injury associated with single or multiple organ failure. The interventions required to manage life-threatening illnesses generally include both core supports—and intensive nursing care and cardiopulmonary monitoring—as well as supports focused on the patient’s particular illness. While nearly all CCUs/ICUs are capable of providing a spectrum of care, many have developed a focused area of excellence: care of critically ill and injured children in the pediatric ICU (PICU); adult cardiac diseases in the coronary care unit (CCU); perioperative care, trauma care, and care of multiple organ dysfunction in the surgical ICU (SICU); care of neurological and neurosurgical patients in the neuroscience ICU and so on. Many teaching hospitals also have graded critical care centers such as intermediate care units and telemetry units where patients who require more than ward care can benefit from specific monitoring and intervention.

Critical care continuum: The series of events that begins when the critically ill or injured person first receives medical treatment, through transport and stabilization, and hospitalization and recovery.

Critical care nurses: Registered nurses who receive highly specialized education and are often certified in critical care nursing as CCRNs. Because of their close contact with the family and the patient, CCRNs often serve as the patient advocate and become integral to the decision-making process of the patient, family and critical care team.

Critical care team: The multidisciplinary team of health care professionals who care for critically ill and injured patients. The critical care team includes the critical care intensivist, critical care nurse, respiratory therapist and pharmacologist. Other allied health therapists and technicians, social workers and clergy may also participate as members of the critical care team.

Critical Care Unit (CCU): A location in the hospital where critical care is provided. Also referred to as the intensive care unit (ICU). Common reasons for admission to the CCU/ICU include: respiratory compromise, hemodynamic compromise, myocardial ischemia or infarction, neurological compromise, life-threatening gastrointestinal bleeding, complications of renal failure and postoperative patients who may still be on a ventilator or may have other invasive monitoring.

FCCS Certified: Fundamental Critical Care Support Certification (FCCS) – Documentation of successful completion of a 2 day comprehensive course addressing fundamental management principals for the first 24 hours of critical care. The course is intended to better prepare the non-intensivist for management of the critically ill patient until transfer or appropriate critical care consultation can be arranged. In addition, the certification is intended to:

• assist the non-intensivist in dealing with sudden deterioration of the critically ill patient;
• prepare house staff for ICU coverage; and
• prepare nurses to deal with acute deterioration in the critically ill patient.

(Society of Critical Care Medicine)

Hospitalists: Hospitalists are physicians who spend at least 25 percent of their professional time serving as the physicians-of-record for inpatients, during which time they accept "hand-offs" of hospitalized patients from primary care providers, returning the patients back to the care of their primary care providers at the time of hospital discharge.

Harm: Harm is death, injury, suffering, dissatisfaction or disability experienced by a person.

Incident: An incident is an event or circumstance that could have, or did, lead to unintended and/or unnecessary harm to a person.

ICU Safety Reporting System: ICUSRS is a pilot, Web-based reporting system being tested by a team of investigators at Johns Hopkins, in collaboration with the Society of Critical Care Medicine and funded by the Agency for Healthcare Research and Quality in a cohort of ICUs across the U.S. The ICUSRS goal is to improve patient safety in intensive care units. To improve safety, systems are needed to identify potential problems that then can be addressed. However, there are significant barriers to reporting and most incidents are neither reported nor acted upon. This represents a lost opportunity and may see the same mistakes recur. An early finding of the ICUSRS is that excessive workload and problems with communications contributed to the majority of mistakes.

Intensive Care Unit (ICU): Same as Critical Care Unit; see definition above.

Intensivists: Board-certified physicians who are additionally certified in the subspecialty of Critical Care Medicine. This certification is awarded by the American Boards of Internal Medicine, Surgery, Anesthesiology and Pediatrics. Because subspecialty certification is not offered in emergency medicine, emergency medicine physicians are considered certified in Critical Care Medicine if they are board-certified in emergency medicine and have completed a critical care follow-up fellowship at an ACEP-accredited program.

Level I units: These units care for the complicated, critically ill patients requiring the continuous availability of sophisticated equipment, specialized nurses and physicians with critical care training. These units are subdivided into Level 1A (academic) and Level IC (comprehensive) units. Both Level I units provide comprehensive critical care, but Level I A units have an additional academic mission. Level I academic units require the additional commitment of the clinical staff to education and research in the field of critical care medicine.

Level II units: These units have limited resources to provide critical care. While these units may be able to deliver a high quality of care to patients with single organ failure, transfer agreements must be arranged for patients whose problems are complex or highly specialized. Standards described for Level II units in these guidelines represent minimal standards required to provide quality care to critically ill patients.

Near miss: A near miss or close call is any incident that could potentially lead to patient harm.

Philosophy of critical care medicine: A physician-led, multidisciplinary team can provide optimal care to the patient. The term multidisciplinary refers not only to other physicians who may participate as consultants or co-attendings in the ICU, but also to other health care professionals who work side by side, around the clock in the ICU. The most numerous of these are critical care nurses. Others include acute care nurse practitioners and clinical nurse specialists who complement the physician staff in establishing plans, writing orders and directing management. Physician assistants also provide care in the ICU. Respiratory therapists are experts in many forms of pulmonary diagnosis and intervention. The ICU team also typically includes a pharmacist, dietitian, medical social worker, chaplain and trainees.

Society of Critical Care Medicine (SCCM): The SCCM is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. SCCM is devoted exclusively to the advancement of multidisciplinary, multi-professional intensive care through excellence in patient care, professional education, research and advocacy. Members include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory therapists and other professionals, which may include technicians, social workers, dieticians and members of the clergy.

System factor: The elements or things that influence how we work. For the ICUSTS study, these elements are broken into six categories:

• Patient factors: Any factors specific to the patient, such as condition (severity of illness), language barriers, behavioral or mental health (combative, delusional, social factors (religious or other beliefs).
• Task factors: Factors relating to the task at hand such as availability of protocols, needed test results.
• Provider factors: Factors relating to the provider, such as his or her knowledge or skill level, fatigue, motivation and attitude.
• Team factors: Any factors that relate to teamwork such as effective communication, supervision, ease in seeking help, team structure.
• ICU environmental factors: Factors that describe the internal structure of a unit such as staffing levels, workload, proper maintenance of equipment, poor/good working space.
• Institutional environmental factors: These factors involve the overall structure of the institution/hospital, such as financial resources, health insurance pressures.

© 2004 Michigan Health and Safety Coalition