अमूर्त

Evaluation of performance in intensive care unit

Alfateh Sayed Mohammed Noor, Abdulrahman M Al-Harthy , Omar E Ramadan , Ahmed F Madi , Mohammed A Al-Odat , Basim M Huwait , Shahzad A Mumtaz , Waleed T Aletreby

Abstract: The intensive care unit (ICU) of any hospital consumes a large portion of the hospital’s budget, which mandates continuous evaluation of the performance of the unit to substantiate its expenditure. Measuring the quality of the performance in the ICU is difficult and complex, however, two identified performance indicators of ICU in terms of effectiveness are length of stay (LOS) of patients, and severity adjusted standardized mortality ratio utilizing a severity related prediction model. Aims: To evaluate the performance in an adult ICU in terms of effectiveness, using predefined targets for the length of stay and standardized mortality ratio, as well as comparison to predicted values. Methods: All discharged patients from our ICU during 2018 were included, the average LOS for all and acute patients, and the mortality rate were calculated, and compared to values predicted by APACHE 4 scoring system. Results: During 2018 we discharged 2769 patients, and 2484 patients met the inclusion criteria.The median LOS for all patients [ 5 ( 2 - 12)] was significantly higher than predicted value of 4 (2 – 11) days (p=0.013), the same was observed for the LOS of acute patients (who spend less than 21 days in ICU), the actual and predicted medians were 4 (2 – 10) and 3 (2 – 6) days respectively (p=0.02), however both LOS calculations were within our pre-set targets of 15 days for all and 5 days for acute patients. The actual mortality rate of 12.5% (95% CI 11.2 – 13.9) was significantly lower than that predicted by the APACHE 4 scoring system (14.6%). Using the actual and predicted mortality rates, the standardized mortality ratio was 0.86. Comparison of the year 2018 to 2017 show a significant reduction of LOS for all patients (p= 0.03), and an insignificant trend toward reduction of mortality rate (p = 0.07) Conclusions: The LOS values for all and acute patients are within targets, and comparable to figures reported in some studies, being above values predicted may be attributed to the fact that APACHE 4 scoring system underestimates LOS. The mortality rate was significantly lower than predicted, and lower than that reported in similar studies. With a standardized mortality ratio of less than 1, there is evidence of an acceptable quality of care in the ICU. However, interventions in the form of performance improvement projects are required to improve the indicators, and consequently the quality of care. There is also improvement in the performance and outcome of our ICU in 2018 as compared to 2017.