PURPOSE: To develop and implement a set of valid and reliable yet practical measures of intensive care units (ICU) quality of care in a cohort of ICUs and to estimate, based on current performance, the potential opportunity to improve quality. METHODS: We included 13 adult medical and surgical ICUs in urban community teaching and community hospitals. To monitor performance on previously identified quality measures, we developed 3 data collection tools: the Team Leader, Daily Rounding, and Infection Control forms. These tools were pilot tested, validated, and modified before implementation. We used published estimates of efficacy to estimate the clinical and economic effect of our current performance for each of the process measures: appropriate sedation, prevention of ventilator-associated pneumonia, appropriate peptic ulcer disease (PUD) prophylaxis, appropriate deep venous thrombosis (DVT) prophylaxis, and appropriate use of blood transfusions. RESULTS: Performance varied widely among the 13 ICUs and within ICUs. The median percentage of days in which ventilated patients received therapies that ought to was 64% for appropriate sedation, 67% for elevating head of bed, 89% for PUD prophylaxis, and 87% for DVT prophylaxis. The median rate of appropriate transfusion was 33%. The failure to use these therapies may lead to excess morbidity, mortality, and ICU length of stay. CONCLUSION: To improve quality of care, we must measure our performance. This pilot study suggests that it is feasible to implement a broad set of ICU quality measures in a cohort of hospitals. By improving performance on these measures, we may realize reduced mortality, morbidity, and ICU length of stay.
PURPOSE: To develop and implement a set of valid and reliable yet practical measures of intensive care units (ICU) quality of care in a cohort of ICUs and to estimate, based on current performance, the potential opportunity to improve quality. METHODS: We included 13 adult medical and surgical ICUs in urban community teaching and community hospitals. To monitor performance on previously identified quality measures, we developed 3 data collection tools: the Team Leader, Daily Rounding, and Infection Control forms. These tools were pilot tested, validated, and modified before implementation. We used published estimates of efficacy to estimate the clinical and economic effect of our current performance for each of the process measures: appropriate sedation, prevention of ventilator-associated pneumonia, appropriate peptic ulcer disease (PUD) prophylaxis, appropriate deep venous thrombosis (DVT) prophylaxis, and appropriate use of blood transfusions. RESULTS: Performance varied widely among the 13 ICUs and within ICUs. The median percentage of days in which ventilated patients received therapies that ought to was 64% for appropriate sedation, 67% for elevating head of bed, 89% for PUD prophylaxis, and 87% for DVT prophylaxis. The median rate of appropriate transfusion was 33%. The failure to use these therapies may lead to excess morbidity, mortality, and ICU length of stay. CONCLUSION: To improve quality of care, we must measure our performance. This pilot study suggests that it is feasible to implement a broad set of ICU quality measures in a cohort of hospitals. By improving performance on these measures, we may realize reduced mortality, morbidity, and ICU length of stay.
Authors: K Kaier; C Wilson; M Hulscher; H Wollersheim; A Huis; M Borg; E Scicluna; M-L Lambert; M Palomar; E Tacconelli; G De Angelis; M Schumacher; M Wolkewitz; E-M Kleissle; U Frank Journal: Infection Date: 2011-08-30 Impact factor: 3.553
Authors: Joan D Penrod; Peter J Pronovost; Elayne E Livote; Kathleen A Puntillo; Amy S Walker; Sylvan Wallenstein; Alice F Mercado; Sandra M Swoboda; Debra Ilaoa; David A Thompson; Judith E Nelson Journal: Crit Care Med Date: 2012-04 Impact factor: 7.598
Authors: Jan-Peter Braun; Hendrik Mende; Hanswerner Bause; Frank Bloos; Götz Geldner; Marc Kastrup; Ralf Kuhlen; Andreas Markewitz; Jörg Martin; Michael Quintel; Klaus Steinmeier-Bauer; Christian Waydhas; Claudia Spies Journal: Ger Med Sci Date: 2010-09-28
Authors: Kirsten Colpaert; Sem Vanbelleghem; Christian Danneels; Dominique Benoit; Kristof Steurbaut; Sofie Van Hoecke; Filip De Turck; Johan Decruyenaere Journal: BMC Med Inform Decis Mak Date: 2010-10-19 Impact factor: 2.796