Quality indicators in respiratory therapy

Table 1 Essential characteristics and description of indicators related to clinical departments

Characteristics	Description
Measurement objective	Statistical performance is measured over time
Structure	About the structure of the department
Process	About the processes in department
Outcomes	About the outcomes in department
Characteristic measured
Quality	Effectiveness, efficiency, equity, patient orientation are the measures of quality
Safety	Timeliness and other aspects of safety are measures of safety
Numerical expression used
Sentinel	When occurrence is rare and can be captured as numbers against time
Percentage	When occurrence is more common and can be easily understood as percentages
Rate	When occurrence needs to be understood and compared to a benchmark
Numerator used
Sentinel	Occurrence in numbers
Percentage	Occurrence in numbers
Rate	Occurrence in numbers
Denominator used
Sentinel	Generally, time in days, weeks, months, or years
Percentage	Total number studied
Rate	Usually, number of patient days
Multiplication factor used
Sentinel	None
Percentage	100
Rate	1000
Formula used
Sentinel	Numerator/Denominator
Percentage	Numerator/Denominator × 100
Rate	Numerator /Denominator × 1000
Definition	Precise definition of numerator and denominator must be made and accepted by all stakeholders
Start and end times	If the indicator measures start or end times, either in numerator or denominator, then these must be precisely defined
Continuous or intermittent monitoring	Some indicators must be monitored continuously without any interruption and others may need intermittent monitoring
Sample size	Sample size must be scientifically planned based on the sample volume. The sampling methodology must be scientifically validated

Table 2 Some of the independent indicators related to the respiratory therapy department

Structural indicators	Process indicators	Outcome indicators
Average number of respiratory therapists in areas like ICU, emergency department, wards, etc.	Patient assessment	Morbidity and mortality related to care
Average number of routine and urgent respiratory visits in the wards	Application of specific oxygen therapy device	Ventilator-associated events
Knowledge regarding departmental clinical practice guidelines	Application of disease-specific ventilation, based on the patients	Ulcers related to artificial airways, non-invasive ventilation masks, etc.
Knowledge regarding airway management and mechanical ventilation	Performing/assisting intubation	Success and failure rates related to care: Successful weaning and extubation, accidental extubation, reintubation rates, etc.
Knowledge on the rights and responsibilities of patients and staff	Performing/assisting arterial line insertion	Equipment utilization indices
	Interpretation of blood gas reports	Equipment down time
		Documented patient feedback

ICU: Intensive care unit.

Table 3 Some of the specific quality and safety indicators relevant to the department of respiratory therapy

No.	Name of indicator	Type	Dimension measured	Frequency of data collection
1	Availability of respiratory therapists in: (1) Acute care settings (ICUs and emergency departments); (2) Wards and outpatient departments; and (3) Pulmonary diagnostics department	Quality	Structure	Monthly
2	Inventory check/availability of calibrated equipment in: (1) Acute care settings (ICUs and emergency departments); and (2) Respiratory therapy departments	Quality	Structure	Monthly
3	Percentage of ventilator circuits changed as per guidelines	Quality	Process	Monthly
4	Percentage of heat and moisture exchange filters that were changed as per guidelines	Quality	Process	Monthly
5	Percentage of patients in adherence to VAP prevention bundle	Safety	Process	Monthly
6	Percentage of patients on semirecumbent posture during MV	Safety	Process	Monthly
7	Average number of routine and urgent respiratory therapy visits	Quality	Process	Monthly
8	Knowledge regarding clinical practice guidelines	Safety	Process	Monthly
9	Infection control practices	Safety	Process	Monthly
10	Patient and staff rights and responsibilities	Quality	Process	Monthly
11	Care plan indicators: (1) Assessment by respiratory therapists; (2) Reassessment by respiratory therapists; and (3) Respiratory care plan	Quality	Process	Monthly
12	Carrying out procedures related to: (1) Oxygen therapy; (2) Nebulization; (3) Humidification; (4) Bronchial hygiene; (5) Artificial airway; (6) Vascular access; (7) Noninvasive or invasive ventilation, and (8) Assistance in invasive procedures such as an arterial line, central line, and chest tube insertion, bronchoscopy, etc.	Safety	Process	Monthly
13	Percentage of patients successfully weaned off from invasive ventilation	Quality	Outcome	Monthly
14	Percentage of patients successfully weaned off from noninvasive ventilation	Quality	Outcome	Monthly
15	Successful spontaneous breathing trials leading to successful extubation	Quality	Outcome	Monthly
16	Percentage of patients intubated on first attempt	Safety	Outcome	Monthly
17	Percentage of patients who could not be intubated after multiple attempts	Safety	Outcome	Monthly
18	Percentage of patients who developed cardiac arrest during intubation	Safety	Outcome	Monthly
19	Percentage of accidental extubation	Safety	Outcome	Monthly
20	Rate of ventilator-associated events	Safety	Outcome	Monthly
21	Morbidity and mortality related to care infection indices (ventilator-associated infections)	Safety	Outcome	Monthly
22	Success and failure rates related to care (e.g., successful extubation, accidental extubation, reintubation rates)	Safety	Outcome	Monthly
23	Equipment and time utilization indices	Safety	Outcome	Monthly
24	Equipment down time	Safety	Outcome	Monthly
25	Patient safety incidents	Safety	Outcome	Monthly

ICU: Intensive care unit; MV: Mechanical ventilation; VAP: Ventilator-associated pneumonia.