Can Standardized Mortality Ratio Be Used To Compare Quality of Intensive Care Unit Performance?

IntroductionThe standardized mortality ratio (SMR) is commonly used to assess the overall quality of care by comparing the observed hospital mortality with the mortality predicted by statistical models. If the observed deaths are less than the predicted, the overall quality of care can be considered high; in the opposite case, it is low.AimThe aim of the study was to assess the overall quality of care in an intensive care unit (ICU) during the period of 2012 to 2017. We also reported our experience and lessons learned throughout the surveillance period.MethodsA retrospective study design was adopted. Healthcare-associated infections (HAI–ICU) protocol v1.1 was used in a major ICU for a period of 6 years. All patients admitted to the ICU during the surveillance period were included in the study. The SMR was measured.ResultsDuring the 6-year period, 1067 patients were admitted and remained hospitalized for more than 48 hours; 207 patients' discharge status was reported as “death”, compared to 309 deaths predicted based on the SAPS II score. The overall mean observed mortality rate during the study period was 19.4%, as opposed to 28.95% for the predicted mortality. The overall mean SMR was 0.62 (IQR 0.49-0.82). Difficulties were faced due to the lack of surveillance software, but they were overcome by the use of a freely available web-based form.ConclusionsThe overall quality of ICU care is considered to correspond to high-quality standards, since standardized mortality rates during the study period were lower than one. The use of the web-based form as an alternative solution to the surveillance software performed well in terms of recording data.

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Correlation of Neonatal Intensive Care Unit Performance Across Multiple Measures of Quality of Care

JAMA Pediatrics ◽

10.1001/jamapediatrics.2013.418 ◽

2013 ◽

Vol 167 (1) ◽

pp. 47 ◽

Cited By ~ 18

Author(s):

Jochen Profit ◽

John A. F. Zupancic ◽

Jeffrey B. Gould ◽

Kenneth Pietz ◽

Marc A. Kowalkowski ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Of Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Multiple Measures ◽

Unit Performance

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Five-Year Outcomes After Implementing a Pain, Agitation, and Delirium Protocol in a Mixed Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/08850666211063404 ◽

2021 ◽

pp. 088506662110634

Author(s):

Jeffrey T. Fish ◽

Jared T. Baxa ◽

Ryan R. Draheim ◽

Matthew J. Willenborg ◽

Jared C. Mills ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Academic Medical Center ◽

Admission Diagnosis ◽

Surgical Intensive Care Unit ◽

Standardized Mortality Ratio ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

Mortality Ratio ◽

Apache Iv

Objective: Assess for continued improvements in patient outcomes after updating our institutional sedation and analgesia protocol to include recommendations from the 2013 Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium (PAD) guidelines. Methods: Retrospective before-and-after study in a mixed medical/surgical intensive care unit (ICU) at an academic medical center. Mechanically ventilated adults admitted from September 1, 2011 through August 31, 2012 (pre-implementation) and October 1, 2012 through September 30, 2017 (post-implementation) were included. Measurements included number of mechanically ventilated patients, APACHE IV scores, age, type of patient (medical or surgical), admission diagnosis, ICU length of stay (LOS), hospital LOS, ventilator days, number of self-extubations, ICU mortality, ICU standardized mortality ratio, hospital mortality, hospital standardized mortality ratio, medication data including as needed (PRN) analgesic and sedative use, and analgesic and sedative infusions, and institutional savings. Results: Ventilator days (Pre-PAD = 4.0 vs. Year 5 post = 3.2, P < .0001), ICU LOS (Pre-PAD = 4.8 days vs. Year 5 post = 4.1 days, P = .0004) and hospital LOS (Pre-PAD = 14 days vs. Year 5 post = 12 days, P < .0001) decreased after protocol implementation. Hospital standardized mortality ratio (Pre-PAD = 0.69 vs. Year 5 post = 0.66) remained constant; while, APACHE IV scores (Pre-PAD = 77 vs. Year 5 post = 89, P < .0001) and number of intubated patients (Pre-PAD = 1146 vs. Year 5 post = 1468) increased over the study period. Using the decreased ICU and hospital LOS estimates, it is projected the institution saved $4.3 million over the 5 years since implementation. Conclusions: Implementation of an updated PAD protocol in a mixed medical/surgical ICU was associated with a significant decrease in ventilator time, ICU LOS, and hospital LOS without a change in the standardized mortality ratio over a five-year period. These favorable outcomes are associated with a significant cost savings for the institution.

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Comparison of intensive care unit mortality performances: standardized mortality ratio vs absolute risk reduction

Critical Care ◽

10.1186/cc5630 ◽

2007 ◽

Vol 11 (Suppl 2) ◽

pp. P470

Author(s):

B Afessa ◽

M Keegan ◽

J Naessens ◽

O Gajic

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Risk Reduction ◽

Intensive Care Unit Mortality ◽

Absolute Risk ◽

Absolute Risk Reduction ◽

Standardized Mortality Ratio ◽

Mortality Ratio

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Faculty Opinions recommendation of Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1103924.561072 ◽

2008 ◽

Author(s):

Jim O'Brien

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Quality Of Care ◽

Teaching Hospital ◽

Provider Satisfaction ◽

On Demand ◽

Care Specialist

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Families' perception, knowledge, and psychological stressors associated with transition of care from the intensive care unit

Journal of Precision Respiratory Medicine ◽

10.2500/jprm.2019.190004 ◽

2019 ◽

Vol 2 (1) ◽

pp. 53-56

Author(s):

Gustavo Ferrer ◽

Chi Chan Lee ◽

Monica Egozcue ◽

Hector Vazquez ◽

Melissa Elizee ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Health Care Providers ◽

Family Members ◽

Expected Improvement ◽

Transition Of Care ◽

Care Providers ◽

Icu Discharge ◽

Family Perceptions

Background: During the process of transition of care from the intensive care setting, clarity, and understanding are vital to a patient's outcome. A successful transition of care requires collaboration between health-care providers and the patient's family. The objective of this project was to assess the quality of continuity of care with regard to family perceptions, education provided, and psychological stress during the process. Methods: A prospective study conducted in a long-term acute care (LTAC) facility. On admission, family members of individuals admitted to the LTAC were asked to fill out a 15-item questionnaire with regard to their experiences from preceding intensive care unit (ICU) hospitalization. The setting was an LTAC facility. Patients were admitted to an LTAC after ICU admission. Results: Seventy-six participants completed the questionnaire: 38% expected a complete recovery, 61% expected improvement with disabilities, and 1.3% expected no recovery. With regard to the length of stay in the LTAC, 11% expected < 1 week, 26% expected 1 to 2 weeks, 21% expected 3 to 4 weeks, and 42% were not sure. Before ICU discharge, 33% of the participants expected the transfer to the LTAC. Also, 72% did not report a satisfactory level of knowledge regarding their family's clinical condition or medical services required; 21% did not receive help from family members; and 50% reported anxiety, 20% reported depression, and 29% reported insomnia. Conclusion: Families' perception of patients' prognosis and disposition can be different from what was communicated by the physician. Families' anxiety and emotional stress may precipitate this discrepancy. The establishment of optimal projects to eliminate communication barriers and educate family members will undoubtedly improve the quality of transition of care from the ICU.

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