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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Central Nervous System Trauma | Research

Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

Authors: Jilske A. Huijben, Eveline J. A. Wiegers, Nicolette F. de Keizer, Andrew I. R. Maas, David Menon, Ari Ercole, Giuseppe Citerio, Fiona Lecky, Lindsay Wilson, Maryse C. Cnossen, Suzanne Polinder, Ewout W. Steyerberg, Mathieu van der Jagt, Hester F. Lingsma, the Delphi panel

Published in: Critical Care | Issue 1/2019

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Abstract

Background

We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.

Methods

A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.

Results

The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%).

Conclusions

This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.
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Metadata
Title
Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury
Authors
Jilske A. Huijben
Eveline J. A. Wiegers
Nicolette F. de Keizer
Andrew I. R. Maas
David Menon
Ari Ercole
Giuseppe Citerio
Fiona Lecky
Lindsay Wilson
Maryse C. Cnossen
Suzanne Polinder
Ewout W. Steyerberg
Mathieu van der Jagt
Hester F. Lingsma
the Delphi panel
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2377-x

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