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:[email protected]
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