Top

Published in:

01-04-2012 | Original

Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)

Authors: A. Rhodes, R. P. Moreno, E. Azoulay, M. Capuzzo, J. D. Chiche, J. Eddleston, R. Endacott, P. Ferdinande, H. Flaatten, B. Guidet, R. Kuhlen, C. León-Gil, M. C. Martin Delgado, P. G. Metnitz, M. Soares, C. L. Sprung, J. F. Timsit, A. Valentin

Published in: Intensive Care Medicine | Issue 4/2012

Abstract

Objectives

To define a set of indicators that could be used to improve quality in intensive care medicine.

Methodology

An European Society of Intensive Care Medicine Task Force on Quality and Safety identified all commonly used key quality indicators. This international Task Force consisted of 18 experts, all with a self-proclaimed interest in the area. Through a modified Delphi process seeking greater than 90% consensual agreement from this nominal group, the indicators were then refined through a series of iterative processes.

Results

A total of 111 indicators of quality were initially found, and these were consolidated into 102 separate items. After five discrete rounds of debate, these indicators were reduced to a subset of nine that all had greater than 90% agreement from the nominal group. These indicators can be used to describe the structures (3), processes (2) and outcomes (4) of intensive care. Across this international group, it was much more difficult to obtain consensual agreement on the indicators describing processes of care than on the structures and outcomes.

Conclusion

This document contains nine indicators, all of which have a high level of consensual agreement from an international Task Force, which could be used to improve quality in routine intensive care practice.

Available only for authorised users

Kohn KTCJ, Donaldson MS (2000) To err is human: building a safer health system. National Academy Press, Washington D.C.

Lilford R, Mohammed MA, Spiegelhalter D, Thomson R (2004) Use and misuse of process and outcome data in managing performance of acute medical care: avoiding institutional stigma. Lancet 363:1147–1154PubMedCrossRef

Sherman H, Castro G, Fletcher M, Hatlie M, Hibbert P, Jakob R, Koss R, Lewalle P, Loeb J, Perneger T, Runciman W, Thomson R, Van Der Schaaf T, Virtanen M (2009) Towards an international classification for patient safety: the conceptual framework. Int J Qual Health Care 21:2–8PubMedCrossRef

Brennan A, Sampson F, Deverill M (2005) Can we use routine data to evaluate organizational change? Lessons from the evaluation of business process re-engineering in a UK teaching hospital. Health Serv Manage Res 18:265–276PubMedCrossRef

Donabedian A (1988) The quality of care. How can it be assessed? JAMA 260:1743–1748PubMedCrossRef

Institute of Medicine’s Committee on Quality of Health Care in America (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington D.C.

Giacomini MK, Cook DJ (2000) Users’ guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? Evidence-based medicine working group. JAMA 284:357–362PubMedCrossRef

Giacomini MK, Cook DJ (2000) Users’ guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group. JAMA 284:478–482

Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P (2009) Errors in administration of parenteral drugs in intensive care units: multinational prospective study. Br Med J 338:b814CrossRef

10.

Valentin A, Capuzzo M, Guidet B, Moreno RP, Dolanski L, Bauer P, Metnitz PG (2006) Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Med 32:1591–1598PubMedCrossRef

11.

Moreno RP, Rhodes A, Donchin Y (2009) Patient safety in intensive care medicine: the Declaration of Vienna. Intensive Care Med 35:1667–1672PubMedCrossRef

12.

Hammond JJ (2001) Protocols and guidelines in critical care: development and implementation. Curr Opin Crit Care 7:464–468PubMedCrossRef

13.

Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, Kane-Gill SL, Kirchhoff KT, Levy M, Mitchell PH, Moreno R, Pronovost P, Puntillo K (2006) Intensive care unit quality improvement: a “how-to” guide for the interdisciplinary team. Crit Care Med 34:211–218PubMedCrossRef

14.

Levy MM (2006) Finding out what we do in the ICU. Crit Care Med 34:227–228PubMedCrossRef

15.

Ferrer R, Artigas A, Levy MM, Blanco J, González-Díaz G, Garnacho-Montero J, Ibáñez J, Palencia E, Quintana M, de la Torre-Prados MV, Group ES (2008) Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 299:2294–2303CrossRef

16.

Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, Schorr C, Artigas A, Ramsay G, Beale R, Parker MM, Gerlach H, Reinhart K, Silva E, Harvey M, Regan S, Angus DC (2010) The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med 36:222–231PubMedCrossRef

17.

Bosk CL, Dixon-Woods M, Goeschel CA, Pronovost PJ (2009) Reality check for checklists. Lancet 374:444–445PubMedCrossRef

18.

Uckay I, Ahmed QA, Sax H, Pittet D (2008) Ventilator-associated pneumonia as a quality indicator for patient safety? Clin Infect Dis 46:557–563PubMedCrossRef

19.

Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL (2002) Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 288:2151–2162PubMedCrossRef

20.

Vincent JL (2000) Need for intensivists in intensive-care units. Lancet 356:695–696PubMedCrossRef

21.

Wu AW, Pronovost P, Morlock L (2002) ICU incident reporting systems. J Crit Care 17:86–94PubMedCrossRef

22.

Needham DM, Thompson DA, Holzmueller CG, Dorman T, Lubomski LH, Wu AW, Morlock LL, Pronovost PJ (2004) A system factors analysis of airway events from the Intensive Care Unit Safety Reporting System (ICUSRS). Crit Care Med 32:2227–2233PubMedCrossRef

23.

Pronovost PJ, Thompson DA, Holzmueller CG, Lubomski LH, Dorman T, Dickman F, Fahey M, Steinwachs DM, Engineer L, Sexton JB, Wu AW, Morlock LL (2006) Toward learning from patient safety reporting systems. J Crit Care 21:305–315PubMedCrossRef

24.

Winters BD, Berenholtz SM, Pronovost P (2007) Improving patient safety reporting systems. Crit Care Med 35:1206–1207PubMedCrossRef

25.

Zhan C, Miller MR (2003) Administrative data based patient safety research: a critical review. Qual Saf Health Care 12 Suppl 2:ii58–63

26.

Holzmueller CG, Pronovost PJ, Dickman F, Thompson DA, Wu AW, Lubomski LH, Fahey M, Steinwachs DM, Engineer L, Jaffrey A, Morlock LL, Dorman T (2005) Creating the web-based intensive care unit safety reporting system. J Am Med Inform Assoc 12:130–139PubMedCrossRef

27.

Rothen HU, Stricker K, Einfalt J, Bauer P, Metnitz PGH, Moreno RP, Takala J (2007) Variability in outcome and resource use in intensive care units. Intensive Care Med 33:1329–1336PubMedCrossRef

28.

Kim MM, Barnato AE, Angus DC, Fleisher LA, Fleisher LF, Kahn JM (2010) The effect of multidisciplinary care teams on intensive care unit mortality. Arch Intern Med 170:369–376PubMedCrossRef

29.

Pickering BW, Hurley K, Marsh B (2009) Identification of patient information corruption in the intensive care unit: using a scoring tool to direct quality improvements in handover. Crit Care Med 37:2905–2912PubMedCrossRef

30.

Catchpole KR, de Leval MR, McEwan A, Pigott N, Elliott MJ, McQuillan A, MacDonald C, Goldman AJ (2007) Patient handover from surgery to intensive care: using Formula 1 pit-stop and aviation models to improve safety and quality. Paediatr Anaesth 17:470–478PubMedCrossRef

31.

Bell CM, Brener SS, Gunraj N, Huo C, Bierman AS, Scales DC, Bajcar J, Zwarenstein M, Urbach DR (2011) Association of ICU or hospital admission with unintentional discontinuation of medications for chronic diseases. JAMA 306:840–847PubMedCrossRef

32.

Kahn JM, Angus DC (2011) Going home on the right medications: prescription errors and transitions of care. JAMA 306:878–879PubMedCrossRef

33.

Moreno RP, Hochrieser H, Metnitz B, Bauer P, Metnitz PG (2010) Characterizing the risk profiles of intensive care units. Intensive Care Med 36:1207–1212PubMedCrossRef

34.

Poole D, Rossi C, Anghileri A, Giardino M, Latronico N, Radrizzani D, Langer M, Bertolini G (2009) External validation of the Simplified Acute Physiology Score (SAPS) 3 in a cohort of 28,357 patients from 147 Italian intensive care units. Intensive Care Med 35:1916–1924PubMedCrossRef

35.

Angus DC (1998) Grappling with intensive care unit quality–does the readmission rate tell us anything? Crit Care Med 26:1779–1780PubMedCrossRef

36.

American College of Critical Care Medicine of the Society of Critical Care Medicine (1999) Guidelines for intensive care unit admission, discharge, and triage. Crit Care Med 27:633–638

37.

Metnitz PGH, Fieux F, Jordan B, Lang T, Moreno R, Le Gall J-R (2003) Critically ill patients readmitted to intensive care units—lessons to learn? Intensive Care Med 29:241–248PubMed

38.

Rosenberg AL, Watts C (2000) Patients readmitted to ICUs*: a systematic review of risk factors and outcomes. Chest 118:492–502PubMedCrossRef

39.

Chittick P, Sherertz RJ (2010) Recognition and prevention of nosocomial vascular device and related bloodstream infections in the intensive care unit. Crit Care Med 38:S363–S372PubMedCrossRef

40.

Dendle C, Martin RD, Cameron DR, Grabsch EA, Mayall BC, Grayson ML, Johnson PDR (2009) Staphylococcus aureus bacteraemia as a quality indicator for hospital infection control. Med J Aust 191:389–392PubMed

41.

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2725–2732PubMedCrossRef

42.

Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli DJ, Cosgrove S, Sexton JB, Marsteller JA, Hyzy RC, Welsh R, Posa P, Schumacher K, Needham D (2010) Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. Br Med J 340:c309CrossRef

43.

Lucet JC, Bouadma L, Zahar JR, Schwebel C, Geffroy A, Pease S, Herault MC, Haouache H, Adrie C, Thuong M, Francais A, Garrouste-Orgeas M, Timsit JF (2010) Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med 38:1030–1035PubMedCrossRef

44.

Vassal T, Anh NG, Gabillet JM, Guidet B, Staikowsky F, Offenstadt G (1993) Prospective evaluation of self-extubations in a medical intensive care unit. Intensive Care Med 19:340–342PubMedCrossRef

45.

Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ, Group MVIS (2002) Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 287:345–355CrossRef

46.

Chevron V, Ménard JF, Richard JC, Girault C, Leroy J, Bonmarchand G (1998) Unplanned extubation: risk factors of development and predictive criteria for reintubation. Crit Care Med 26:1049–1053PubMedCrossRef

47.

Penuelas O, Frutos-Vivar F, Esteban A (2011) Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation. Crit Care 15:128PubMedCrossRef

48.

de Groot RI, Dekkers OM, Herold IH, de Jonge E, Arbous MS (2011) Risk factors and outcomes after unplanned extubations on the ICU: a case–control study. Crit Care 15:R19PubMedCrossRef

Title: Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)
Authors: A. Rhodes
R. P. Moreno
E. Azoulay
M. Capuzzo
J. D. Chiche
J. Eddleston
R. Endacott
P. Ferdinande
H. Flaatten
B. Guidet
R. Kuhlen
C. León-Gil
M. C. Martin Delgado
P. G. Metnitz
M. Soares
C. L. Sprung
J. F. Timsit
A. Valentin
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2462-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)

Abstract

Objectives

Methodology

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methodology

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2012

RETRACTED ARTICLE: Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction

Retraction of “Concomitant measurement of copeptin and high-sensitivity troponin for fast and reliable rule out of acute myocardial infarction”

Preventing ventilator-associated pneumonia: is it ultimately only a matter of gravity?

Dismissal of the utility of free cortisol measurement is premature: response to Cohen et al.

In vivo conditioning of acid–base equilibrium by crystalloid solutions: an experimental study on pigs

Dismissal of the utility of free cortisol measurement is premature