Developing quality measures for sepsis care in the ICU.
BACKGROUND
Sepsis is associated with increased morbidity, mortality, and costs of care. Although several therapies improve outcomes in patients with sepsis, rigorously developed measures to evaluate quality of sepsis care in the intensive care unit (ICU) are lacking.


METHODS
To select an initial set of candidate measures, in 2003-2004 an interdisciplinary panel reviewed the literature and used a modified nominal group technique to identify interventions that improve outcomes of patients with sepsis in the ICU. Design specifications or explicit definitions for each candidate measure were developed.


RESULTS
Ten potential measures were identified: vancomycin administration, time to vancomycin initiation, broad-spectrum antibiotic administration, time to broad-spectrum antibiotic initiation, blood culture collection, steroid administration, corticotropin stimulation test administration, activated protein C eligibility assessment, activated protein C administration, and vancomycin discontinuation.


CONCLUSIONS
The identification of potential measures of quality of care for patients with sepsis can help caregivers to focus on evidence-based interventions that improve mortality and to evaluate their current performance. Further work is needed to evaluate the feasibility and validity of the measures.
Berenholtz
Sean M
SM
Anesthesiology/Critical Care Medicine and Surgery, The Johns Hopkins University, Baltimore, USA. sberenho@jhmi.edu
Pronovost
Peter J
PJ
Ngo
Koni
K
Barie
Philip S
PS
Hitt
John
J
Kuti
Joseph L
JL
Septimus
Edward
E
Lawler
Nancy
N
Schilling
Lisa
L
Dorman
Todd
T
D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care / Q000592:standards*; D018805:Sepsis / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States