Background:We performed a directed environmental scan to identify and categorize quality indicators unique to critical care that are reported by key stakeholder organizations. Methods:We convened a panel of experts (n = 9) to identify key organizations that are focused on quality improvement or critical care, and reviewed their online publications and website content for quality indicators. We identified quality indicators specific to the care of critically ill adult patients and then categorized them according to the Donabedian and the Institute of Medicine frameworks. We also noted the organizations' rationale for selecting these indicators and their reported evidence base. Results:From 28 targeted organizations, we identified 222 quality indicators, 127 of which were unique. Of the 127 indicators, 63 (32.5%) were safety indicators and 61 (31.4%) were effectiveness indicators. The rationale for selecting quality indicators was supported by consensus for 58 (26.1%) of the 222 indicators and by published research evidence for 45 (20.3%); for 119 indicators (53.6%), the rationale was not reported or the reader was referred to other organizations' reports. Of the 127 unique quality indicators, 27 (21.2%) were accompanied by a formal grading of evidence, whereas for 52 (40.9%), no reference to evidence was provided. Interpretation:There are many quality indicators related to critical care that are available in the public domain. However, owing to a paucity of rationale for selection, supporting evidence and results of implementation, it is not clear which indicators should be adopted for use. AbstractResearch Research CMAJ OPENCMAJ OPEN, 5(2) E489 Methods Search strategyThe study was conducted at the University of Ottawa and the University of Montreal. We convened a panel of experts to identify organizations that have interests in quality of care or intensive care. We invited 10 intensivists with expertise in quality improvement (including the development, implementation and evaluation of quality initiatives), epidemiology and systematic reviews. Selection of panel members was based on 2 criteria: scientific productivity in critical care, and clinical and methodological expertise in literature review. In addition, we sought geographic representativeness among the panel members, and we included investigators from Ontario, Quebec, British Columbia and Alberta. The panel members were involved in study design and are included as authors. Two authors (P.H. and S.V.) were involved in the selection and invitation of panel members. We identified Canadian and provincial organizations (n = 15) (i.e., provincial health care quality councils and critical care societies) as well as a convenience sample of major international organizations (n = 13) using the panel of experts' recommendations. We specifically sought information from international intensive care societies and statewide integrated health care systems that contributed to the science of development and implementation of quality indicators. This international samp...
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