ICU quality and management tools explained

Intensive Care Unit (ICU) quality and management tools refer to a range of strategies, technologies, and practices aimed at improving patient outcomes, operational efficiency, and safety within the Intensive Care Unit (ICU).

ICU quality tools

Quality tools include:^[1]

• Medical guidelines, including checklists^[2] (items rated as yes/no/not applicable).
• Templates^[3] for goal setting or structured communication (a more open format than checklists, which provide ability to add free text responses with items as prompts).
• Care bundles, including ABCDE(F) bundle^[4] (Assess, prevent and manage pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium assessment, prevention and management, Early mobility and exercise, Family engagement and empowerment).

Medical scoring systems can be used to describe ICU populations and explain their different outcomes. Examples include:

• APACHE II
  • SAPS II SAPS III
• Mortality Probability Model (MPM)

Physical tools include:

• Monitoring (medicine), which may provide data for analysis of ICU performance.

ICU management tools

Severity assessment tools

Examples of severity assessment tools:^[5]

• Pneumonia severity index (PSI) or PORT score)
• CURB65 score
• CRB65 score
• American Thoracic Society (ATS) 2001 criteria
• Infectious Disease Society of America/ATS (IDSA/ATS) 2007 criteria
• Panic Disorder Screener (PADIS) guidelines^[6]

Risk stratification tools

Risk stratification tools examples:^[7]

• Early warning score such as the Modified Early Warning Score (MEWS), to predict ICU readmission, and the Pediatric early warning signs (PEWS) score
• Minimizing ICU Readmission (MIR) score^[8], to predict patient death or ICU readmission.
• Sabadell score, which predicts hospital mortality after ICU discharge.
• Stability and Workload Index for Transfer (SWIFT) score^[9] and the Frost nomogram, to predict ICU readmission.

See also

• APACHE II
• SAPS III
• Intensive care medicine
• Intensive care unit

References

• Gallesio. Antonio O.. Ceraso. Daniel. Palizas. Fernando. Improving Quality in the Intensive Care Unit Setting. Critical Care Clinics. July 2006. 22. 3. 547–571. 10.1016/j.ccc.2006.04.002. 16893740. 1557-8232.
• Garland. Allan. Improving the ICU: part 1.. Chest. June 2005. 127. 6. 2151–64. 10.1378/chest.127.6.2151. 15947333. American College of Chest Physicians.
• Garland. Allan. Improving the ICU: part 2.. Chest. June 2005. 127. 6. 2165–79. 10.1378/chest.127.6.2165. 15947334. American College of Chest Physicians.
• Knaus. William A.. Draper. Elizabeth A.. Wagner. Douglas P.. Zimmerman. Jack E.. APACHE II: a severity of disease classification system. Critical Care Medicine. October 1985. 13. 10. 818–29. 10.1097/00003246-198510000-00009. 3928249.
• McMillan. Tracy R.. Hyzy. Robert C.. Bringing quality improvement into the intensive care unit. Critical Care Medicine. February 2007. 35. 2 Suppl. S59–S65. 10.1097/01.CCM.0000252914.22497.44. 17242607. Society of Critical Care Medicine and Lippincott Williams & Wilkins.
• The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil. Zampieri FG, Soares M, Borges LP, Salluh JIF, Ranzani OT.Rev Bras Ter Intensiva. 2017 Oct-Dec;29(4):418-426. doi: 10.5935/0103-507X.20170062. Epub 2017 Nov 30.
• New perspectives to improve critical care benchmarking. Salluh JIF, Chiche JD, Reis CE, Soares M.Ann Intensive Care. 2018 Feb 2;8(1):17. doi: 10.1186/s13613-018-0363-0.
• 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.

External links

• APACHE II Score online
• SAPS II Scoring Sheets and Database

Notes and References

1. Allum, Laura, et al. "Informing the standardising of care for prolonged stay patients in the intensive care unit: A scoping review of quality improvement tools." Intensive and Critical Care Nursing 73 (2022): 103302.
2. Erikson, Ethan J., et al. "The use of checklists in the intensive care unit: a scoping review." Critical Care 27.1 (2023): 468.
3. Iannello, Justin, Nida Waheed, and Patrick Neilan. "Template Design and Analysis: Integrating Informatics Solutions to Improve Clinical Documentation." Federal Practitioner 37.11 (2020): 527.
4. da Silva Moraes, Fabio, et al. "ABCDE and ABCDEF care bundles: A systematic review protocol of the implementation process in intensive care units." Medicine 98.11 (2019): e14792.
5. Chalmers, James D., et al. "Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis." Intensive care medicine 37 (2011): 1409-1420.
6. "SCCM | PADIS Guidelines" I. Society of Critical Care Medicine (SCCM). Retrieved 2023-08-15.
7. Hosein . F. Shaun . Bobrovitz . Niklas . Berthelot . Simon . Zygun . David . Ghali . William A. . Stelfox . Henry T. . 3 . A systematic review of tools for predicting severe adverse events following patient discharge from intensive care units . Critical Care . 29 June 2013 . 17 . 3 . R102. 10.1186/cc12747 . en . free . 23718698 . 4056089 . 1364-8535.
8. Ouanes, Islem, et al. "A model to predict short-term death or readmission after intensive care unit discharge." Journal of critical care 27.4 (2012): 422-e1.
9. Gajic, Ognjen, et al. "The Stability and Workload Index for Transfer score predicts unplanned intensive care unit patient readmission: initial development and validation." Critical care medicine 36.3 (2008): 676-682.