1. Louie Plenderleith

2. New Case mix adjustment Systems

5. Scottish Intensive Care Society Audit Group, Annual Report 2003. www.scottishintensivecare.org.uk Scottish SMRs by APACHE system: 2001.

6. Calibration

7. Apache II Exclusions 551 patients (6%) excluded Age < 16 yrs Stay < 8 hours Diagnosis

8. Bundles

9. Knaus WA, Draper EA, Wagner DP, et al: APACHE II: A severity of disease classification system. Crit Care Med 1985

10. Ideal Scoring System More Accurate Inclusive Same (or less) data Free

11. New Scoring methods SAPS 3 (2005) – 19,507 patients, 305 ICUs, 4 Continents APACHE IV (2006) 131,618 patients, 104 ICUs, USA ICNARC Method (2007) – 231,930 patients, 163 ICUs, England, Wales & NI

12. ICNARC Calibration

13. SAPS 3 Calibration

14. APACHE IV Calibration

15. Exclusions APACHE IV – Readmissions – < 16 years – < 4 hours – Admitted from another ICU – Hospital Stay > 1 year SAPS 3 – Readmissions – < 16 years ICNARC – Readmissions

16. Data collected currently ICNARC modelAPACHE IVSAPS III Heart rateHighestMost abnormalHighest TempHighestMost abnormalHighest Respiratory RateLowestMost abnormal IntubatedY /N PaO2/FlO2Both requiredBoth RequiredBoth required Acid BaseLowest pHpCO2 / pH grid Urea Highest Most abnormal CreatinineHighestMost abnormal (Modified in ARF)Highest SodiumHighestMost abnormal BilirubinMost abnormalHighest Urine Output (24 hours)Yes HaematocritMost abnormal WBC Lowest Most abnormalHighest Paralyzed/sedated?Yes (scored)Use GCS from up to 12 hours previously GCSLowest (unless sedated)Gridlowest Chronic HealthCurrent listown list, but all present AgeYes yes Source of AdmissionYes CPRadditional coefficient Length of Stay pre ICUYes Type of surgeryIn Source of Admission Planned or unplanned admissionyes

17. Data not collected ICNARC modelAPACHE IVSAPS III BPLowest systolic BPmost abnormal MAPLowest Systolic AlbuminMost abnormal GlucoseMost abnormal PlateletsLowest Diagnosis / reason for admissionNew list Limited list Site of surgeryLimited list Preadmission RxInotropes Acute infection at ICU AdmissionYes / No

18. Cost SAPS 3Public domain APACHE 4Public domain ICNARCNot public Domain

19. Should we Change Loss of historical comparisons Probably no change in data collection burden Have to relearn definitions Will it work better for SICSAG?

20. What do we do?