Editorial
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Nov 4, 2014; 3(4): 74-79
Published online Nov 4, 2014. doi: 10.5492/wjccm.v3.i4.74
Intensive care performance: How should we monitor performance in the future?
Tim K Timmers, Michiel HJ Verhofstad, Karl GM Moons, Luke PH Leenen
Tim K Timmers, Luke PH Leenen, Department of Surgery, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
Michiel HJ Verhofstad, Department of Surgery, Erasmus Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
Karl GM Moons, Department of Clinical Epidemiology, Julius Centre for Health Sciences and Primary Care, 3508 GA Utrecht, The Netherlands
Author contributions: All the authors contributed to this paper.
Correspondence to: Tim K Timmers, MD, PhD, Department of Surgery, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. tk.timmers@gmail.com
Telephone: +31-88-7559882 Fax: +31-88-7555555
Received: June 10, 2014
Revised: September 24, 2014
Accepted: October 14, 2014
Published online: November 4, 2014
Processing time: 152 Days and 23.2 Hours
Abstract

Intensive care faces economic challenges. Therefore, evidence proving both effectiveness and efficiency, i.e., cost-effectiveness, of delivered care is needed. Today, the quality of care is an important issue in the health care debate. How do we measure quality of care and how accurate and representative is this measurement? In the following report, several topics which are used for the evaluation of intensive care unit (ICU) performance are discussed: (1) The use of general outcome prediction models to determine the risk of patients who are admitted to ICUs in an increasing variety of case mix for the different intensive care units, together with three major limitations; (2) As critical care outcomes research becomes a more established entity, mortality is now only one of many endpoints that are relevant. Mortality is a limited outcome when assessing critical care performance, while patient interest in quality of life outcomes is relevant; and (3) The Quality Indicators Committee of the Society of Critical Care Medicine recommended that short-term readmission is a major performance indicator of the quality of intensive care medicine.

Keywords: Intensive care performance; Quality of care; Critical care; Intensive care medicine

Core tip: Variations in case mix, intensive care unit (ICU) demographics, clinical and non-clinical factors not addressed by the present severity of illness scores must be quantified to improve the accuracy of future prediction models. A completely different benefit using health-related quality of life (HrQoL) as a performance benchmark could be the follow-up evaluation of the patient’s health status after ICU or hospital discharge. The moment when outcome research can predict the short-term (ICU discharge) QoL of a critically ill patient during the first 24 h of ICU admission will give physicians and health care policy makers an up-to-date and reliable evaluation of quality of care in the ICU for the future.