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©The Author(s) 2016.
World J Crit Care Med. May 4, 2016; 5(2): 165-170
Published online May 4, 2016. doi: 10.5492/wjccm.v5.i2.165
Published online May 4, 2016. doi: 10.5492/wjccm.v5.i2.165
Table 1 Critical Care Independent Multidisciplinary Program defined metrics
Metric | Description | Variables needed | |
M1 | Hospital length of stay for ICU graduates - unadjusted | Hospital length of stay is based on all patients discharged from the hospital during the specified time-frame. A patient may have multiple admissions to the ICU | Hospital Admission Hospital Discharge ICU admission ICU discharge |
M2 | ICU length of stay - unadjusted | ICU length of stay is based on all patients discharged from the ICU during the specified time-frame | ICU admission ICU discharge |
M3 | ICU length of stay - adjusted | Adjusted ICU length of stay is based on all patients discharged from the ICU during the specified time-frame. Expected ICU length of stay is the APACHE IV predicted ICU length of stay. Adjusted length of stay is observed ICU length of stay divided by expected ICU length of stay | ICU admission ICU discharge APACHE IV bundle (demographic, vitals, labs, Glasgow coma score, health conditions, time stamps and geolocations, procedures and diagnosis) |
M4 | ICU readmission rate | Readmission summary is based on all patients admitted to the ICU during the specified time-frame. An admission is counted as a readmission if it is not the patient’s first admission to the ICU during that hospital stay. Readmissions to the same ICU and readmissions within 24 h are summarized | ICU admission ICU discharge Admission source (location) |
M5 | ICU admissions | Admission summary is based on all patients admitted to the ICU during the specified time-frame | ICU admission ICU discharge |
M6 | ICU admission source and admission service | Admission source summary is based on all patients admitted to the ICU during the specified time-frame | ICU admission ICU discharge Admission source (location) |
M7 | Duration of mechanical ventilation | Ventilation summary is based on all patients discharged from the ICU during the specified time- frame. Use of invasive and non-invasive ventilation is summarized as well as the median duration. Numbers for invasive and non-invasive ventilation will not sum to the numbers for ventilation because patients may have both types | ICU admission ICU discharge Duration invasive or non-invasive ventilation for each day of ICU stay |
M8 | ICU mortality rate - unadjusted | Mortality rate summary is based on all patients discharged from the ICU during the specified time frame. Multiple discharges per patient are allowed | ICU admission ICU discharge Patient status |
M9 | ICU mortality rate - adjusted | Mortality summary is based on all patients discharged from the ICU during the specified time-frame. Multiple discharges per patient are allowed. Expected ICU mortality is based on each patient’s APACHE IV predicted probability of hospital death. Standard mortality ratio is calculated by dividing observed ICU mortality by expected APACHE IV hospital mortality | ICU admission ICU discharge Patient status APACHE III/IV bundle (demographic, vitals, labs, Glasgow coma score, health conditions, time stamps and geolocations, procedures and diagnosis) |
M10 | ICU admissions for low-risk monitoring | Low-risk monitoring summary is based on all patients admitted to the ICU during the specified time-frame. Low risk monitoring calculation based on the TISS-28 score[27]. Patients with score 0-13 are considered low-risk monitoring | ICU admission ICU discharge TISS-28 score bundle (vitals, labs, orders, procedures) |
M11 | ICU census - hourly utilization | Unit utilization summarizes the average hourly unit utilization for each specified time-frame on the hourly ending census | ICU admission ICU discharge Number of bed per unit |
Table 2 Clinical characteristics of baseline cohort
Number | Characteristic1 | Overall (n = 93) |
1 | Age (yr) | 73 (62, 83) |
2 | Male sex | 53 (57%) |
3 | APACHE III score | 60 (46.5, 72) |
4 | SOFA score | 3 (2, 5) |
5 | ICU type | |
Medical | 51 (56%) | |
Surgical | 29 (30%) | |
Mixed | 13 (14%) | |
Ventilator use | ||
6 | Invasive | 18 (19.4%) |
7 | Non-invasive | 22 (23.7%) |
8 | ICU length of stay (d) | 1.1 (0.9, 2.1) |
9 | ICU mortality | 1 (1%) |
10 | Hospital length of stay (d) | 5.4 (3.6, 11.1) |
11 | Hospital mortality | 10 (10.7%) |
Table 3 Agreement of admission, discharge, and transfer information
Component | Agreement |
Admit/discharge times1 | |
ICU admission | 99% |
ICU discharge | 89% |
Hospital admission | 100% |
Hospital discharge | 100% |
Pre-ICU location | 100% |
Admission ICU | 100% |
ICU discharge location | 100% |
Table 4 Analysis of sensitivity and specificity
Variables and their usage for metrics | Sensitivity | Specificity | True positive | False positive | True negative | False negative |
MV use (from M7) | 100% | 94.40% | 75 | 1 | 17 | 0 |
NIV use (from M7) | 100% | 95.50% | 71 | 1 | 21 | 0 |
ICU mortality (M8, M9) | 100% | 100% | 0 | 0 | 93 | 0 |
In-hospital mortality | 100% | 100% | 10 | 0 | 83 | 0 |
- Citation: Dziadzko MA, Thongprayoon C, Ahmed A, Tiong IC, Li M, Brown DR, Pickering BW, Herasevich V. Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use. World J Crit Care Med 2016; 5(2): 165-170
- URL: https://www.wjgnet.com/2220-3141/full/v5/i2/165.htm
- DOI: https://dx.doi.org/10.5492/wjccm.v5.i2.165