Quality assessment in intensive care units: proposal for a scoring system in terms of structure and process.
OBJECTIVE
We present a score for assessing the quality of ICU care in terms of structure and process, based on bibliographic review, expert consultations, field test, analysis, and final consensus, and analyze its initial application in the field.


METHODS
This feasibility and observational study was conducted within the framework of a French regional clinical research project (NosoQual); 40 ICUs were visited and assessed between November 2002 and March 2003 according to standardized procedures.


RESULTS
The grid consisted of 95 variables. The overall score derived from seven independent quality dimensions: human resources, architecture, safety and environment, management of documentation, patient care management, risk management of infections and evaluation, and surveillance. The average level of achievement of the scores varied from 48% to 63% of theoretical maxima. Variability in the individual dimensional subscores was greater than that of the overall score (CV=15).


CONCLUSIONS
Evaluation this scoring system encounters the limitation of the absence of a "gold standard." However, this is counterbalanced by the rigorous design methodology, the characteristic strengths of the quality dimensions. The survey also highlights also feasibility and the potential interest for specific tools for the assessment of ICUs.
Najjar-Pellet
Josette
J
Université de Lyon, Laboratoire d'Epidémiologie et Santé Publique, 8 avenue Rockefeller, 69373, Lyon Cedex 08, France. josette.najjar@univ-lyon1.fr
Jonquet
Olivier
O
Jambou
Patrick
P
Fabry
Jacques
J
D003697:Delphi Technique; D005240:Feasibility Studies; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000145:classification / Q000592:standards*; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care