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 2006
Centre for prevention and health services research
Email:maartje.de.vos@rivm.nl
National Institute for Public Health and Environment
Outline presentation
• Background
• Study methods
• Results: selected set of quality indicators for ICU
• Results: variation among ICUs
Background
• 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:
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 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
indicators
Case mix
age,gender
Structure
Process
 Intensivist availability
• ICU lenght of stay
 Nurse to patiënt ratio
 Medication error prevention policy
 Registration of patiënt/family
satisfaction
• Duration of mechanical ventilation
• Frequency of interclinical transport
• Frequency 100% occupation
• Glucose dysregulation
Outcome
 Mortality
 Incidence of severe decubitus
 Frequency of unplanned
extubation
Pilot 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 Study
• Results (feasibility)
Investment of time to register
- 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
37% 30-60
17%> 60 min
Results (examples of crude data)
• 7682 admissions, 31849 treatment days
Ratio employed (fellow) intensivists/ number of beds
18
20
ov
er
al
l
18
20
17
16
15
13
12
11
10
9
7
6
5
4
3
2
1
1
0,8
0,6
0,4
0,2
0
Median time mechanical ventilation (days)
4
2
O
ve
ra
ll
17
16
15
13
12
11
10
9
8
7
6
5
4
3
0
2
days
6
Conclusion
• 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