Quality Management in the ICU Mazen Kherallah, MD, FCCP Chairman, Critical Care Department King Faisal Specialist Hospital & Research Center.

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Presentation transcript:

Quality Management in the ICU Mazen Kherallah, MD, FCCP Chairman, Critical Care Department King Faisal Specialist Hospital & Research Center

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

Administration Quality Clinical service Ancillary service Others Individual Functions

Administration Quality Clinical service Ancillary service Others Interaction: Links

Quality Clinical service Ancillary service Others Order Administration

Facility Quality Clinical service Ancillary service Others Group Function

Quality Indicators Length of stay Unscheduled return to OR Readmission rate to ICU Reintubation rate Medication errors Blood utilization rates Infectious complication rate Inappropriate empiric antimicrobial coverage Iatrogenic pneumothorax rate

Quality Management

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

Length of Stay

LOS Benchmark

Sepsis LOS Benchmark

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

Bars show percents noyes Re-admission to ICU 0% 25% 50% 75% Percent n=235 94% n=16 6% Patients Re-admitted to ICU

Patients Re-admitted to ICU Benchmark

Patients Re-admitted to ICU

Mortality of Re-admitted Patients

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

Device-Associated Infectious Rates

Device-Associated Infection Rates Medical/Surgical ICU Benchmarked with NNIS Denominator: Device-Days

NIC, Trend

VAP

CR-BSI

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

DDD’s

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

Inappropriate Empiric Antibiotic Coverage 8.2%

Causes of Inappropriateness MDR pseudomonas(1) ESBL E. Coli (1) Sensitive pseudomonas(1) Aeromonas (1) Stenotrophomonas (1) Yeast (1)

Quality Management Issues APACHE II Length of Stay Patients re-admitted to ICU Nosocomial infections in ICU Antibiotic utilization Inappropriateness of empiric antibiotic coverage Mortality review

ICU Mortality Rates >35 SMR: Standardized Mortality Ratio: < 1

Hospital Mortality of ICU patients

Hospital Mortality Rates >35 SMR: Standardized Mortality Ratio: < 1 SMR >1

Mortality of Patients Receiving Prolonged Mechanical ventilation (>2 days) Armando J et al. Chest2002;121: ICU Mortality Hospital Mortality 2-Month Mortality

Mortality as per Diagnosis

Mortality as per Referring Service

Age Distribution

Age Distribution and Referring Service Medicine Surgery Cardiothoracic Oncology Neuroscience Years

Distribution of APACHE II/Terminal Illness on Arrival to ICU Advanced malignancy ESLD Brain death Severe brain injury End-stage lung disease APACHE II score

Quality Issues Potentially preventable Possibly preventable No quality issues Poor respiratory care, early ICU discharge Failure to recognize life threatening disease Delayed diagnosis Years Questionable procedure indication

It should be there when you need it!