Reliability of In-hospital Mortality as a Quality Indicator in Clinical Quality Registries

Koetsier, Antonie; Peek, Niels; Jonge, Eric de; Dongelmans, Dave A.; Berkel, G. van; Keizer, Nicolette de

doi:10.3414/me12-02-0070

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…Another strength of our study is our concrete primary endpoint (1-yr survival), which was possible due to the relatively long-term follow-up period. Finally, the NICE registry is considered to be a reliable source of high-quality data (32).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care

Vries

Müller

Arbous

et al. 2019

Critical Care Medicine

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Objectives:Historically, patients with a hematologic malignancy have one of the highest mortality rates among cancer patients admitted to the ICU. Therefore, physicians are often reluctant to admit these patients to the ICU. The aim of our study was to examine the survival of patients who have a hematologic malignancy and multiple organ failure admitted to the ICU.Design:This retrospective cohort study, part of the HEMA-ICU study group, was designed to study the survival of patients with a hematologic malignancy and organ failure after admission to the ICU. Patients were followed for at least 1 year.Setting:Five university hospitals in the Netherlands.Patients:One-thousand ninety-seven patients with a hematologic malignancy who were admitted at the ICU.Interventions:None.Measurements and Main Results:Primary outcome was 1-year survival. Organ failure was categorized as acute kidney injury, respiratory failure, hepatic failure, and hemodynamic failure; multiple organ failure was defined as failure of two or more organs. The World Health Organization performance score measured 3 months after discharge from the ICU was used as a measure of functional outcome. The 1-year survival rate among these patients was 38%. Multiple organ failure was inversely associated with long-term survival, and an absence of respiratory failure was the strongest predictor of 1-year survival. The survival rate among patients with 2, 3, and 4 failing organs was 27%, 22%, and 8%, respectively. Among all surviving patients for which World Health Organization scores were available, 39% had a World Health Organization performance score of 0–1 3 months after ICU discharge. Functional outcome was not associated with the number of failing organs.Conclusions:Our results suggest that multiple organ failure should not be used as a criterion for excluding a patient with a hematologic malignancy from admission to the ICU.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care

Vries

Müller

Arbous

et al. 2019

Critical Care Medicine

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“…Currently, all these 82 ICUs collect data on demographics, physiology and clinical diagnoses of all patients admitted to their ICU and deliver these data monthly to the Dutch National Intensive Care Evaluation (NICE) registry 30. Collected data are checked by registry staff for internal consistency, by performing onsite data quality audits and training local data collectors 31. The NICE registry has enabled participating ICUs to quantify and improve their quality of care by offering them feedback with benchmark information on patient outcomes such as mortality and length of stay for more than 20 years.…”

Section: Methodsmentioning

confidence: 99%

Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial

et al. 2019

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BackgroundAudit and feedback (A&F) enjoys widespread use, but often achieves only marginal improvements in care. Providing recipients of A&F with suggested actions to overcome barriers (action implementation toolbox) may increase effectiveness.ObjectiveTo assess the impact of adding an action implementation toolbox to an electronic A&F intervention targeting quality of pain management in intensive care units (ICUs).Trial designTwo-armed cluster-randomised controlled trial. Randomisation was computer generated, with allocation concealment by a researcher, unaffiliated with the study. Investigators were not blinded to the group assignment of an ICU.ParticipantsTwenty-one Dutch ICUs and patients eligible for pain measurement.InterventionsFeedback-only versus feedback with action implementation toolbox.OutcomeProportion of patient-shift observations where pain management was adequate; composed by two process (measuring pain at least once per patient in each shift; re-measuring unacceptable pain scores within 1 hour) and two outcome indicators (acceptable pain scores; unacceptable pain scores normalised within 1 hour).Results21 ICUs (feedback-only n=11; feedback-with-toolbox n=10) with a total of 253 530 patient-shift observations were analysed. We found absolute improvement on adequate pain management in the feedback-with-toolbox group (14.8%; 95% CI 14.0% to 15.5%) and the feedback-only group (4.8%; 95% CI 4.2% to 5.5%). Improvement was limited to the two process indicators. The feedback-with-toolbox group achieved larger effects than the feedback-only group both on the composite adequate pain management (p<0.05) and on measuring pain each shift (p<0.001). No important adverse effects have occurred.ConclusionFeedback with toolbox improved the number of shifts where patients received adequate pain management compared with feedback alone, but only in process and not outcome indicators.Trial registration numberNCT02922101.

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“…To ensure that the data are of a high quality, ICU employees are trained in how to score patients, the data are checked before being read into the database, and data quality audits are carried out [22–25]. …”

Section: Methodsmentioning

confidence: 99%

Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices

Sluisveld¹,

Bakhshi‐Raiez

Keizer

et al. 2017

BMC Health Serv Res

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BackgroundVariation in intensive care unit (ICU) readmissions and in-hospital mortality after ICU discharge may indicate potential for improvement and could be explained by ICU discharge practices. Our objective was threefold: (1) describe variation in rates of ICU readmissions within 48 h and post-ICU in-hospital mortality, (2) describe ICU discharge practices in Dutch hospitals, and (3) study the association between rates of ICU readmissions within 48 h and post-ICU in-hospital mortality and ICU discharge practices.MethodsWe analysed data on 42,040 admissions to 82 (91.1%) Dutch ICUs in 2011 from the Dutch National Intensive Care Evaluation (NICE) registry to describe variation in standardized ICU readmission and post-ICU mortality rates using funnel-plots. We send a questionnaire to all Dutch ICUs. 75 ICUs responded and their questionnaire data could be linked to 38,498 admissions in the NICE registry. Generalized estimation equations analyses were used to study the association between ICU readmissions and post-ICU mortality rates and the identified discharge practices, i.e. (1) ICU discharge criteria; (2) bed managers; (3) early discharge planning; (4) step-down facilities; (5) medication reconciliation; (6) verbal and written handover; (7) monitoring of post-ICU patients; and (8) consulting ICU nurses. In all analyses, the outcomes were corrected for patient-related confounding factors.ResultsThe standardized rate of ICU readmissions varied between 0.14 and 2.67 and 20.8% of the hospitals fell outside the 95% control limits and 3.6% outside the 99.8% control limits. The standardized rate of post-ICU mortality varied between 0.07 and 2.07 and 17.1% of the hospitals fell outside the 95% control limits and 4.9% outside the 99.8% control limits. We could not demonstrate an association between the eight ICU discharge practices and rates of ICU readmissions or post-ICU in-hospital mortality. Implementing a higher number of ICU discharge practices was also not associated with better patient outcomes.ConclusionsWe found both variation in patient outcomes and variation in ICU discharge practices between ICUs. However, we found no association between discharge practices and rates of ICU readmissions or post-ICU mortality. Further research is necessary to find factors, which may influence these patient outcomes, in order to improve quality of care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2234-z) contains supplementary material, which is available to authorized users.

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Reliability of In-hospital Mortality as a Quality Indicator in Clinical Quality Registries

Cited by 13 publications

References 23 publications

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care

Long-Term Outcome of Patients With a Hematologic Malignancy and Multiple Organ Failure Admitted at the Intensive Care

Impact of audit and feedback with action implementation toolbox on improving ICU pain management: cluster-randomised controlled trial

Variation in rates of ICU readmissions and post-ICU in-hospital mortality and their association with ICU discharge practices

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