Developing and pilot testing quality indicators in the intensive care unit.
OBJECTIVE
To develop and implement a set of valid and reliable yet practical measures of intensive care units (ICU) quality of care in a cohort of ICUs and to estimate, based on current performance, the potential opportunity to improve quality.


METHODS
We included 13 adult medical and surgical ICUs in urban community teaching and community hospitals. To monitor performance on previously identified quality measures, we developed 3 data collection tools: the Team Leader, Daily Rounding, and Infection Control forms. These tools were pilot tested, validated, and modified before implementation. We used published estimates of efficacy to estimate the clinical and economic effect of our current performance for each of the process measures: appropriate sedation, prevention of ventilator-associated pneumonia, appropriate peptic ulcer disease (PUD) prophylaxis, appropriate deep venous thrombosis (DVT) prophylaxis, and appropriate use of blood transfusions.


RESULTS
Performance varied widely among the 13 ICUs and within ICUs. The median percentage of days in which ventilated patients received therapies that ought to was 64% for appropriate sedation, 67% for elevating head of bed, 89% for PUD prophylaxis, and 87% for DVT prophylaxis. The median rate of appropriate transfusion was 33%. The failure to use these therapies may lead to excess morbidity, mortality, and ICU length of stay.


CONCLUSIONS
To improve quality of care, we must measure our performance. This pilot study suggests that it is feasible to implement a broad set of ICU quality measures in a cohort of hospitals. By improving performance on these measures, we may realize reduced mortality, morbidity, and ICU length of stay.
Pronovost
Peter J
PJ
Department of Anesthesiology/Critical Care Medicine, Surgery, Health Policy and Management, The Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD 21287, USA. ppronovo@jhmi.edu
Berenholtz
Sean M
SM
Ngo
Koni
K
McDowell
Marcy
M
Holzmueller
Christine
C
Haraden
Carol
C
Resar
Roger
R
Rainey
Tom
T
Nolan
Tom
T
Dorman
Todd
T
D015331:Cohort Studies; D003422:Critical Care / Q000592:standards*; D003625:Data Collection / Q000379:methods / Q000592:standards; D017144:Focus Groups; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012107:Research Design