Article

Admission and discharge criteria for intensive care departments

Afd. Intensive Care, Afd. Thoraxanesthesiologie, Isala Klinieken, locatie Weezenlanden, Postbus 10.500, 8000 GM Zwolle.
Nederlands tijdschrift voor geneeskunde 02/2003; 147(3):110-5.
Source: PubMed

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.

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    • "To obtain observational studies, the Medical Subject Headings casecontrol studies and retrospective studies were added. A limited set of additional articles was included, which was suggested by experts [9] [10] [11] [12] [13] [14] [15] [16]. Also, the Cochrane Library Issue [17] was searched by using the keywords intensive care, critical care, ICU, and quality of health care. "
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    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.
    Full-text · Article · Jan 2008 · Journal of Critical Care
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    • "The outcome variable of the present study was LOS, defined as the time in days between admission and discharge from the ICU. Admission to and discharge from the ICU were based on the national protocol [4]. For patients discharged to the ward and readmitted to the ICU within 48 hours, the intervening stay on the ward was included in the LOS. "
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    Full-text · Article · Feb 2007 · Critical care (London, England)
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    ABSTRACT: There is increasing interest in developing quality indicators for the Dutch health care system. The Dutch Health Care Inspectorate (IGZ) requested the National Institute for Public Health and the Environment (RIVM) to develop indicators for the quality of the intensive care to support their inspection activities. This study was carried out in close collaboration with the Dutch Society of Intensive Care Medicine (NVIC). To define quality indicators for Intensive Care Units (ICU), three steps were made. First, a literature search was carried out. Second, a selection of indicators was made by a panel of experts using a questionnaire and ranking in a consensus procedure. Third, a feasibility study was done for six months in eighteen ICU's to evaluate the feasibility of the use of the identified quality indicators. The literature search and the consensus procedure resulted in a set of twelve indicators. Finally, after the feasibility study, eleven indicators were selected. 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, absolute number, proportion of days with all ICU beds occupied, and proportion of glucose measurement above 8.0 mmol/l or below 2.2 mmol/l. The selected outcome indicators are: standardised mortality (APACHE II), incidence of sore pressures, number of unplanned extubations. The time for registration varied from less than 30 minutes to more than one hour per day to collect the items. Among other factors, this variation in workload was related to the availability of computerised systems to collect the data. In this study a set of eleven 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 computerised data-collection system is important for an acceptable workload. In Nederland is in toenemende mate aandacht voor de ontwikkeling van kwaliteitsindicatoren voor de gezondheidszorg. De Inspectie voor de Gezondheidszorg (IGZ) heeft opdracht gegeven aan het Rijksinstituut voor Volksgezondheid en Milieu (RIVM) om indicatoren te ontwikkelen voor de intensive care (ic) om haar taak als toezichthouder te ondersteunen. Hierbij is intensief samengewerkt met de Nederlandse Vereniging voor Intensive Care (NVIC). Er zijn drie stappen gemaakt om te komen tot een set kwaliteitsindicatoren. In de eerste stap zijn indicatoren gezocht in de literatuur over de kwaliteit van zorg op de ic. De tweede stap was het maken van een selectie op basis van consensus tussen experts met behulp van een vragenlijst. In de derde stap is gedurende zes maanden een pilotstudie uitgevoerd op achttien ic-afdelingen om de haalbaarheid van de registratie te evalueren. Op basis van consensus is een selectie gemaakt van de indicatoren uit de literatuur en die aangedragen door experts. Dit resulteerde in een set van twaalf indicatoren. Na de pilotstudie worden uiteindelijk elf indicatoren aanbevolen voor landelijke implementatie. De volgende structuurindicatoren zijn geselecteerd: beschikbaarheid intensivist, verpleegkundige/patientratio, beleid ter voorkoming van medicatiefouten en het registreren van familie- en patienttevredenheid. Vier procesindicatoren zijn geselecteerd: ic-verblijfsduur, beademingsduur, glucoseregulatie en 100%-bezetting. De geselecteerde uitkomstindicatoren zijn: mortaliteit, decubitus incidentie en aantal ongeplande extubaties. De tijd voor het verzamelen van de gegevens varieerde van dertig minuten tot meer dan een uur per dag. Deze verschillen hadden te maken met het feit of er gebruikgemaakt werd van een registratiemodule. In deze studie is een set van elf indicatoren geselecteerd op basis van een literatuurstudie, expert opinion en een pilotstudie. De set geeft een snel overzicht van de kwaliteit van zorg op individuele ic-afdelingen. Om landelijke implementatie mogelijk te maken, is een elektronische dataverzameling van belang.
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