[Admission and discharge criteria for intensive care departments].
ABSTRACT Admission and discharge criteria for intensive care departments have been drawn up in order to optimise the use of scarce and costly intensive care facilities. Every patient who could benefit from admission must be assessed by the intensive care specialist beforehand. Admission is indicated for patients with disrupted vital functions in whom recovery of dysfunctioning or failing organ systems is expected, patients who will act as organ donors and patients who undergo diagnostic investigations associated with a high risk of vital complications. Frequent assessment (several times per day) of the 'indication to stay' is indicated in the case of many patients in order to maximise the admission capacity. Discharge from the intensive care department is indicated if the vital functions are stable without life support and no longer require monitoring or treatment, if nursing the patient in the ward is possible, if continuation of the medical treatment is no longer worthwhile, if the patient no longer consents to the treatment and if the benefit of a treatment no longer outweights its negative effects.
- SourceAvailable from: Peter H J van der Voort[show abstract] [hide abstract]
ABSTRACT: This study was conducted to develop a set of indicators that measure the quality of care in intensive care units (ICU) in Dutch hospitals and to evaluate the feasibility of the registration of these indicators. To define potential indicators for measuring quality, 3 steps were made. First, a literature search was carried out to obtain peer-reviewed articles from 2000 to 2005, describing process or structure indicators in intensive care, which are associated with patient outcome. Additional indicators were suggested by a panel of experts. Second, a selection of indicators was made by a panel of experts using a questionnaire and ranking in a consensus procedure. Third, a study was done for 6 months in 18 ICUs to evaluate the feasibility of using the identified quality indicators. Site visits, interviews, and written questionnaires were used to evaluate the use of indicators. Sixty-two indicators were initially found, either in the literature or suggested by the members of the expert panel. From these, 12 indicators were selected by the expert panel by consensus. After the feasibility study, 11 indicators were eventually selected. "Interclinical transport," referring to a change of hospital, was dropped because of lack of reliability and support for further implementation by the participating hospitals in the study. The following structure indicators were selected: availability of intensivist (hours per day), patient-to-nurse ratio, strategy to prevent medication errors, measurement of patient/family satisfaction. Four process indicators were selected: length of ICU stay, duration of mechanical ventilation, proportion of days with all ICU beds occupied, and proportion of glucose measurement exceeding 8.0 mmol/L or lower than 2.2 mmol/L. The selected outcome indicators were as follows: standardized mortality (APACHE II), incidence of decubitus, number of unplanned extubations. The time for registration varied from less than 30 minutes to more than 1 hour per day to collect the items. Among other factors, this variation in workload was related to the availability of computerized systems to collect the data. In this study, a set of 11 quality indicators for intensive care was defined based on literature research, expert opinion, and testing. The set gives a quick view of the quality of care in individual ICUs. The availability of a computerized data collection system is important for an acceptable workload.Journal of Critical Care 01/2008; 22(4):267-74. · 2.50 Impact Factor
- Critical Care Medicine 11/2005; 33(10):2409-10. · 6.12 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Effective planning of elective surgical procedures requiring postoperative intensive care is important in preventing cancellations and empty intensive care unit (ICU) beds. To improve planning, we constructed, validated and tested three models designed to predict length of stay (LOS) in the ICU in individual patients. Retrospective data were collected from 518 consecutive patients who underwent oesophagectomy with reconstruction for carcinoma between January 1997 and April 2005. Three multivariable linear regression models for LOS, namely preoperative, postoperative and intra-ICU, were constructed using these data. Internal validation was assessed using bootstrap sampling in order to obtain validated estimates of the explained variance (r2). To determine the potential gain of the best performing model in day-to-day clinical practice, prospective data from a second cohort of 65 consecutive patients undergoing oesophagectomy between May 2005 and April 2006 were used in the model, and the predictive performance of the model was compared with prediction based on mean LOS. The intra-ICU model had an r2 of 45% after internal validation. Important prognostic variables for LOS included greater patient age, comorbidity, type of surgical approach, intraoperative respiratory minute volume and complications occurring within 72 hours in the ICU. The potential gain of the best model in day-to-day clinical practice was determined relative to mean LOS. Use of the model reduced the deficit number (underestimation) of ICU days by 65 and increased the excess number (overestimation) of ICU days by 23 for the cohort of 65 patients. A conservative analysis conducted in the second, prospective cohort of patients revealed that 7% more oesophagectomies could have been accommodated, and 15% of cancelled procedures could have been prevented. Patient characteristics can be used to create models that will help in predicting LOS in the ICU. This will result in more efficient use of ICU beds and fewer cancellations.Critical care (London, England) 02/2007; 11(2):R42. · 4.72 Impact Factor