Quality indicators in intensive care medicine for Germany – third edition 2017

Kumpf, Oliver; Braun, Jan-Peter; Brinkmann, Alexander; Bause, Hanswerner; Bellgardt, Martin; Bloos, Frank; Dubb, Rolf; Greim, Clemens‐Alexander; Kaltwasser, Arnold; Marx, Gernot; Riessen, Reimer; Spies, Claudia; Weimann, Jörg; Wöbker, Gabriele; Muhl, Elke; Waydhas, Christian

doi:10.3205/000251

Cited by 40 publications

(17 citation statements)

References 146 publications

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“…Some of these quality indicators (e.g., goals of therapy, sedation depth, pain scale, conversations with relatives and therapy limitations) were reported to be systematically documented in most ICUs. On the other hand, some quality indicators, such as those recommended by the European Society of Intensive Care Medicine [ 22 ] and the German Interdisciplinary Association of Intensive and Emergency Medicine [ 23 ], were found to be documented in only half of the surveyed ICUs. Similarly, only half of the respondents reported that written management protocols were available for certain procedures or selected pathologies.…”

Section: Discussionmentioning

confidence: 99%

The Austrian ICU survey

Schlömmer

Schittek

Meier³

et al. 2022

Wien Klin Wochenschr

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Background While structures of intensive care medicine in Austria are well defined, data on organisational and medical practice in intensive care units (ICUs) have not been systematically evaluated. Methods In this explorative survey, organisational and medical details of ICUs in Austria were collected using an online questionnaire consisting of 147 questions. Results Out of 249 registered ICUs 73 (29.3%) responded, 60 were adult, 10 pediatric/neonatal ICUs and 19, 25 and 16 ICUs were located in level I, II and III hospitals, respectively. Of the respondents 89% reported that the ICU director was board-certified in intensive care medicine. Consultants were constantly present in 78% of ICUs during routine working hours and in 45% during nights and weekends. The nurse:bed ratio varied between 1:1 and 1:2 in 74% during day shifts and 60% during night shifts. Routine physiotherapist rounds were reported to take place daily except weekends in 67% of ICUs. Common monitoring techniques were reported to be in routine or occasional use in 85% and 83% of ICUs, respectively. The majority of ICUs provided daily visiting hours ranging between 2–12 h. Waiting rooms for relatives were available in 66% and an electronic documentation system in 66% of ICUs. Written protocols were available in 70% of ICUs. Conclusion The Austrian ICU survey suggests that ICUs in Austria are clearly structured, well-organized and well-equipped and have a high nurse:bed ratio. In view of the relatively low return rate we cannot exclude that a selection bias has led to overestimation of the survey findings. Supplementary Information The online version of this article (10.1007/s00508-021-02002-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The Austrian ICU survey

Schlömmer

Schittek

Meier³

et al. 2022

Wien Klin Wochenschr

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“…In other medical disciplines, such as intensive care medicine, national expert associations have already published comparable QI bundles. The German Interdisciplinary Association of Intensive Care and Emergency Medicine (DIVI) published a set of 10 treatment-focused QI that are already available in the third edition [ 11 ]. To the best of our knowledge, the present set of 10 QI, comprising structure, process and outcome indicators on a national level is unique in anesthesia [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Implementation of anesthesia quality indicators in Germany

et al. 2020

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Background In 2016 the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthetists (BDA) published 10 quality indicators (QI) to compare and improve the quality of anesthesia care in Germany. So far, there is no evidence for the feasibility of implementation of these QI in hospitals. Objective This study tested the hypothesis that the implementation of the 10 QI is feasible in German hospitals. Material and methods This prospective three-phase national multicenter quality improvement study was conducted in 15 German hospitals and 1 outpatient anesthesia center from March 2017 to February 2018. The trial consisted of an initial evaluation of pre-existing structures and processes by the heads of the participating anesthesia departments, followed by a 6-month implementation phase of the QI as well as a final re-evaluation phase. The implementation procedure was supported by web-based implementation aids (www.qi-an.org) and internal quality management programs. The primary endpoint was the difference in the number of implemented QI per center before and after implementation. Secondary endpoints were the number of newly implemented QI per center, the overall number of successful implementations of each QI, the identification of problems during the implementation as well as the kind of impediments preventing the QI implementation. Results The average number of implemented QI increased from 5.8 to 6.8 (mean of the differences 1.1 ± 1.3; P < 0.01). Most frequently the QI perioperative morbidity and mortality report (5 centers) and the QI temperature management (4 centers) could be implemented. After the implementation phase, the QI incidence management and patient blood management were implemented in all 16 centers. Implementation of other quality indicators failed mainly due to a lack of time and lack of structural resources. Conclusion In this study the implementation of QI was proven to be mostly feasible in the participating German hospitals. Although several QI could be implemented with minor effort, more time, financial and structural resources would be required for some QI, such as the QI postoperative visit.

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“…Selection criteria were: (1) no additional workload required for documentation, (2) the availability within the PDMS system, (3) standardised values for all patients and the existence of standard operating procedures for each indicator and (4) the relevance of the indicator for clinical decision making. 19 23 …”

Section: Methodsmentioning

confidence: 99%

“…24 This process is directly linked to a specific QI for weaning derived from the DIVI-QI. 19 A definition of the indicator is presented in online supplemental material .…”

Section: Methodsmentioning

confidence: 99%

“…20 QIs empower advances in intensive care medicine to be measured and evaluated on a regular basis. 19 QIs can be defined as representative figures for quality of structure, processes or outcome within the medical care process. Thus, indicators are useful for measuring improvement in the context of QM and should be developed in line with evidence-based literature.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Does adherence to a quality indicator regarding early weaning from invasive ventilation improve economic outcome? A single-centre retrospective study

et al. 2022

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ObjectivesTo measure and assess the economic impact of adherence to a single quality indicator (QI) regarding weaning from invasive ventilation.DesignRetrospective observational single-centre study, based on electronic medical and administrative records.SettingIntensive care unit (ICU) of a German university hospital, reference centre for acute respiratory distress syndrome.ParticipantsRecords of 3063 consecutive mechanically ventilated patients admitted to the ICU between 2012 and 2017 were extracted, of whom 583 were eligible adults for further analysis. Patients’ weaning protocols were evaluated for daily adherence to quality standards until ICU discharge. Patients with <65% compliance were assigned to the low adherence group (LAG), patients with ≥65% to the high adherence group (HAG).Primary and secondary outcome measuresEconomic healthcare costs, clinical outcomes and patients’ characteristics.ResultsThe LAG consisted of 378 patients with a median negative economic results of −€3969, HAG of 205 (−€1030), respectively (p<0.001). Median duration of ventilation was 476 (248; 769) hours in the LAG and 389 (247; 608) hours in the HAG (p<0.001). Length of stay (LOS) in the LAG on ICU was 21 (12; 35) days and 16 (11; 25) days in the HAG (p<0.001). LOS in the hospital was 36 (22; 61) days in the LAG, and within the HAG, respectively, 26 (18; 48) days (p=0.001).ConclusionsHigh adherence to this single QI is associated with better clinical outcome and improved economic returns. Therefore, the results support the adherence to QI. However, the examined QI does not influence economic outcome as the decisive factor.

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Quality indicators in intensive care medicine for Germany – third edition 2017

Cited by 40 publications

References 146 publications

The Austrian ICU survey

The Austrian ICU survey

Implementation of anesthesia quality indicators in Germany

Does adherence to a quality indicator regarding early weaning from invasive ventilation improve economic outcome? A single-centre retrospective study

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