Intensive care performance: How should we monitor performance in the future?

Abstract

Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e. , cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit (ICU) performance are discussed: (1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations; (2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and (3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Intensive care performance; Quality of care; Critical care; Intensive care medicine Core tip: Variations in case mix, intensive care unit (ICU) demographics, clinical and non-clinical factors not addressed by the present severity of illness scores must be quantified to improve the accuracy of future prediction models. A completely different benefit using health-related quality of life (HrQoL) as a performance benchmark could be the follow-up evaluation of the patient's health status after ICU or hospital discharge. The moment when outcome research can predict the short-term (ICU discharge) QoL of a critically ill patient during the first 24 h of ICU admission will give physicians and health care policy makers an up-to-date and reliable evaluation of quality of care in the ICU for the future.Timmers TK, Verhofstad MHJ, Moons KGM, Leenen LPH. Intensive care performance: How should we monitor performance in the future? World J Crit Care Med 2014; 3(4): 74-79 Available from:

Comparison of Unplanned Intensive Care Unit Readmission Scores: A Prospective Cohort Study

“…Risk stratification of patients discharged from the ICU is a complex process with many potential challenges. Several risk stratification tools have been developed; however, at present it is unclear whether the existing tools provide value above clinical judgment or whether they can be used to improve healthcare delivery [ 7 – 14 ]. Previously identified predictors of death or ICU readmission include duration of ICU stay, Glasgow Coma Scale at the time of ICU discharge, mean arterial blood pressure, and ICU admission source [ 15 ].…”

Measuring the nursing workload in intensive care with the Nursing Activities Score (NAS): A prospective study in 16 hospitals in Belgium

“…Nursing staff account for 60% of the direct costs of the Intensive Care Unit (ICU) budget [1]. Thus, an objective strategy to evaluate nursing activities is essential to optimize the use of resources and to avoid overstaffing, especially with current budget constraints [2][3][4].…”

Performance of the Pediatric Index of Mortality 3 Score in PICUs in Argentina: A Prospective, National Multicenter Study

“…In the field of intensive care, the standardized mortality ratio (SMR), an indicator that compares the observed number of deaths with the predicted number of deaths in a specific period, is typically employed to assess the performance of PICUs (5). An SMR of 1 indicates a perfect agreement between observed and estimated mortality.…”