How To Evaluate Intensive Care Unit Performance During The COVID-19 Pandemic
Zampieri FG, Soares M, Salluh JIF.
Rev Bras Ter Intensiva. 2020 Jun;32(2):203-206. doi: 10.5935/0103-507x.20200040. Epub 2020 Jul 13.
by: The LOGIC Team
Linking Of Global Intensive Care (LOGIC): An International Benchmarking In Critical Care Initiative
Abstract:
Benchmarking is a common and effective method for measuring and analyzing ICU performance. With the existence of national registries, objective information can now be obtained to allow benchmarking of ICU care within and between countries. The present manuscript briefly describes the current status of benchmarking in healthcare and critical care and presents the LOGIC project, an initiative to promote international benchmarking for intensive care units. Currently 13 registries have joined LOGIC. We showed large differences in the utilization of ICU as well as resources and in outcomes. Despite the need for careful interpretation of differences due to variation in definitions and limited risk adjustment, LOGIC is a growing worldwide initiative that allows access to insightful epidemiologic data from ICUs in multiple databases and registries.
Establishing A Critical Care Network In Asia To Improve Care For Critically Ill Patients In Low- And Middle-Income Countries
CRIT CARE ASIA.
Crit Care. 2020 Oct 15;24(1):608. doi: 10.1186/s13054-020-03321-7.
Intensive Care For COVID-19 In Low- And Middle-Income Countries: Research Opportunities And Challenges
Salluh JIF, Burghi G, Haniffa R.
Intensive Care Med. 2021 Feb;47(2):226-229. doi: 10.1007/s00134-020-06285-y. Epub 2020 Nov 13.
National Registries: Lessons Learnt From Quality Improvement Initiatives In Intensive Care
Abstract:
National clinical quality registries (CQRs) are effective tools for improving the outcomes of patients admitted to the intensive care unit (ICU), and are increasingly important as healthcare needs evolve. A high-quality ICU CQR is built from a foundation of common requirements and challenges. First, performance indicators of the structure, process, or outcomes of patient care should measure what is important. Second, high data quality is essential and can be collected and curated through standardized processes. Third, standardized mortality ratio (SMR) is a cornerstone for benchmarking ICU performance, but application requires a comprehensive understanding of its context and potential pitfalls. Fourth, data collection alone is insufficient. Quality improvement comes from closing the feedback loop by identifying and managing unwarranted practice variation. Fifth, the process of improving healthcare is fundamentally a human enterprise, subject to behavioural change, including those that modify performance. Sixth, ICU CQRs must be dynamic to meet the needs of an evolving healthcare system and stakeholders. Finally, these lessons are far from comprehensive. Sharing perspectives on the development of ICU CQRs can help maximise their value as a powerful platform for informing policy development and improving the outcomes of patients admitted to the ICU.
by: The LOGIC Team
Prediction Of Intensive Care Units Length Of Stay: A Concise Review
Abstract:
The length of stay (LOS) in the intensive care unit (ICU) is one of the most commonly used metrics for quality of care. Despite its potential limitations, ICU LOS is easy to measure, reproducible and can be used as a proxy for resource use, costs, and efficiency.(1) Moreover, it is a patient-centered outcome; therefore, it is of interest to multiple stakeholders, such as patients and families, managers, payors, and ICU personnel. However, in most circumstances, the ICU LOS is used retrospectively to assess ICU efficiency or to understand patients with a long LOS and, thus, elevated costs of care. Therefore, patient LOS prediction at ICU admission could help coordinate care, implement preventive measures, and better communicate with managers, payors, and families, setting realistic expectations.
by: The LOGIC Team
What Intensive Care Registries Can Teach Us About Outcomes
Abstract:
Purpose of review: Critical care registries are synonymous with measurement of outcomes following critical illness. Their ability to provide longitudinal data to enable benchmarking of outcomes for comparison within units over time, and between units, both regionally and nationally is a key part of the evaluation of quality of care and ICU performance as well as a better understanding of case-mix. This review aims to summarize literature on outcome measures currently being reported in registries internationally, describe the current strengths and challenges with interpreting existing outcomes and highlight areas where registries may help improve implementation and interpretation of both existing and new outcome measures.
Recent findings: Outcomes being widely reported through ICU registries include measures of survival, events of interest, patient-reported outcomes and measures of resource utilization (including cost). Despite its increasing adoption, challenges with quality of reporting of outcomes measures remain. Measures of short-term survival are feasible but those requiring longer follow-ups are increasingly difficult to interpret given the evolving nature of critical care in the context of acute and chronic disease management. Furthermore, heterogeneity in patient populations and in healthcare organisations in different settings makes use of outcome measures for international benchmarking at best complex, requiring substantial advances in their definitions and implementation to support those seeking to improve patient care.
Summary: Digital registries could help overcome some of the current challenges with implementing and interpreting ICU outcome data through standardization of reporting and harmonization of data. In addition, ICU registries could be instrumental in enabling data for feedback as part of improvement in both patient-centred outcomes and in service outcomes; notably resource utilization and efficiency.
by: The LOGIC Team
The Limitations Of Standardized Mortality Ratios For Coronavirus Disease 2019 ICU Patients
Quintairos A, Zampieri FG, Souza-Dantas VC, Salluh JIF.
Crit Care Med. 2021 Jul 29.
by: The LOGIC Team
Time To Revisit Treatment Limitations In Critical Care Benchmarking
Beane A, Dongelmans DA, Fernandez AL, Guidet B, Haniffa R, Arias Lopez MP, Pilcher D, Salluh J, Vijayaraghavan BKT; Linking of Global Intensive Care Collaboration (LOGIC).
Crit Care Med. 2021 Apr 1;49(4):e472-e473. doi: 10.1097/CCM.0000000000004834.
Data-Driven ICU Management: Using Big Data And Algorithms To Improve Outcomes
Abstract
The digitalization of the Intensive Care Unit (ICU) led to an increasing amount of clinical data being collected at the bedside. The term “Big Data” can be used to refer to the analysis of these datasets that collect enormous amount of data of different origin and format. Complexity and variety define the value of Big Data. In fact, the retrospective analysis of these datasets allows to generate new knowledge, with consequent potential improvements in the clinical practice. Despite the promising start of Big Data analysis in medical research, which has seen a rising number of peer-reviewed articles, very limited applications have been used in ICU clinical practice. A close future effort should be done to validate the knowledge extracted from clinical Big Data and implement it in the clinic.
In this article, we provide an introduction to Big Data in the ICU, from data collection and data analysis, to the main successful examples of prognostic, predictive and classification models based on ICU data. In addition, we focus on the main challenges that these models face to reach the bedside and effectively improve ICU care.