National Institute for Public Health and Environment

Naam van de presentator(en) | datum

Development and Evaluation of Quality Indicators in the Intensive Care Unit: Preliminary Results

Maartje de Vos, Wilco C.Graafmans | 26 June 2006Centre for prevention and health services researchEmail:maartje.de.vos@rivm.nl

Outline presentationOutline presentation

• Background

• Study methods

• Results: selected set of quality indicators for ICU

• Results: variation among ICUs

BackgroundBackground• Growing need/expectation to measure quality of care in the

Netherlands, e.g. at ICUs

• Measurement by quality Indicators: screening tool to identify potential sub-optimal clinical care

• Different types of indicators (Donabedian): structure, process, and outcome indicators

• Learn and improve from indicators by comparing results with reference values and comparison among hospitals

Objectives Objectives

• Objectives:

1) to develop a set of quality indicators for the ICU and,

2) to evaluate the use of these indicators in a pilot study

Quality indicators for internal use, to stimulate improvement of quality of care at ICUs

Supported by the Dutch Health Care Inspectorate and the Association of Medical Specialists

Development of indicatorsDevelopment of indicators

• Methods- Literature search: 50 indicators

- Expert opinion:12 indicators

• Working group: Dutch Society of Intensive Care (NVIC)

• Selection based on relevance for quality, feasibility, and potential for improvement

• By consensus among experts 12 indicators were selected

Set of Set of indicatorsindicators

Process

• ICU lenght of stay• Duration of mechanical ventilation• Frequency of interclinical transport• Frequency 100% occupation• Glucose dysregulation

Structure

Intensivist availability Nurse to patiënt ratio Medication error prevention policy Registration of patiënt/family satisfaction

Outcome

Mortality Incidence of severe decubitus Frequency of unplanned extubation

Case mix

age,gender

Pilot StudyPilot Study

• Aim: to evaluate the feasibility of the registration of the indicators To obtain data for analyses

• Methods - 18 ICUs- Registration during 6 months- Data collected in a national database (NICE)- Site visits, interviews - Questionnaire (time te register, workload and perceived validity and

reliability)

Pilot StudyPilot Study• Results (feasibility)

- Time to register per day• 46% < 30 min

• 37% 30-60 min

• 17% > 60 min

- Workload was acceptable for

86% of the respondents

- Interclinical transport and

unplanned extubation were the least reliable collected items

- > 80% supported further implementation for 9 indicators

46%< 30 min

17%> 60 min

Investment of time to register

37% 30-60

Results (examples of crude data)Results (examples of crude data)• 7682 admissions, 31849 treatment days

Ratio employed (fellow) intensivists/ number of beds

00,20,40,60,8

1

1 2 3 4 5 6 7 9 10 11 12 13 15 16 17 18 20

over

all

Median time mechanical ventilation (days)

0

2

4

6

days

ConclusionConclusion• A set of 12 indicators was defined: 4 structure, 5 process and 3 outcome

• Workload of registration was acceptable but computer assistance is necessary

• Crude data of scores of indicators

discriminate among hospitals

Future plans:- Adjusting the set for implementation

- Analysis for interpretation and feed back

• Research on case mix