Despite progress in measuring the quality and safety of medical care, there still is no comprehensive set of standardized outcomes measures specifically designed for high-risk settings such as intensive care units (ICUs)—a large and growing component of health care.
What the Study Found
Commonwealth Fund–supported researchers surveyed nearly 200 physicians about their views on nine quality and safety indicators proposed for ICU care: three infectious conditions occurring more than 48 hours after ICU admission (central line–associated bloodstream infection, or CLABSI; Methicillin-resistant Staphylococcus aureus, or MRSA; and septic shock), as well as six noninfectious conditions occurring more than 24 hours post–ICU admission (acute lung injury/acute respiratory distress syndrome, acute renal failure, arrhythmias, gastrointestinal bleeding, pressure ulcer, and pulmonary embolism).
With regard to preventability, four of the nine measures (septic shock, acute lung injury, acute renal failure, and arrhythmias) received negative scores from ICU physicians, meaning they disagreed that the conditions could be readily avoided by following current best-care practices. The other five conditions, however, were seen as good candidates for evaluating quality of care. Physicians also agreed that a mechanism to adjust for the relative severity of cases is important for accurately and fairly comparing outcomes across ICUs or hospitals.
The authors note that "establishing consensus around measures among clinicians is a critical step before investing the resources necessary for pilot-testing," and call for additional work to define, validate, and test the measures.