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Salluh JIF, Amado F, Pilcher D, Hashmi M. The relevance and sustainability of registry-embedded research for critical care. J Crit Care 2024; 82:154765. [PMID: 38492521 DOI: 10.1016/j.jcrc.2024.154765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Jorge I F Salluh
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil; Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipe Amado
- D'OR Institute for Research and Education, Rio de Janeiro, Brazil.
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC 3004, Australia; The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, High Street, Prahran, VIC 3004, Australia
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2
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Suffredini DA. The Standardized Mortality Ratio and ICU Benchmarking: An Old Measure That Is Still Missing the Mark. Crit Care Med 2024; 52:498-501. [PMID: 38381010 DOI: 10.1097/ccm.0000000000006109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Dante A Suffredini
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC
- Department of Medicine, Georgetown University School of Medicine, Washington, DC
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3
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Roos-Blom MJ, Bakhshi-Raiez F, Brinkman S, Arbous MS, van den Berg R, Bosman RJ, van Bussel BCT, Erkamp ML, de Graaff MJ, Hoogendoorn ME, de Lange DW, Moolenaar D, Spijkstra JJ, de Waal RAL, Dongelmans DA, de Keizer NF. Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study. J Crit Care 2024; 79:154461. [PMID: 37951771 DOI: 10.1016/j.jcrc.2023.154461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry. MATERIALS AND METHODS We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC). RESULTS 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021. CONCLUSIONS Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.
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Affiliation(s)
- Marie-José Roos-Blom
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | - Ferishta Bakhshi-Raiez
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Sylvia Brinkman
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - M Sesmu Arbous
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Leiden University Medical Center, Intensive Care Medicine, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roy van den Berg
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Elisabeth TweeSteden Hospital, Intensive Care Medicine, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, the Netherlands
| | - Rob J Bosman
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; OLVG, Intensive Care Medicine, Amsterdam, the Netherlands
| | - Bas C T van Bussel
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Maastricht University Medical Center, Intensive Care Medicine, 6229 HX Maastricht, the Netherlands
| | - Michiel L Erkamp
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Dijklander Ziekenhuis, Intensive Care Medicine, Purmerend, the Netherlands
| | - Mart J de Graaff
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; St. Antonius Hospital, Intensive Care Medicine, Nieuwegein, the Netherlands
| | - Marga E Hoogendoorn
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Isala, Department of Anesthesiology and Intensive Care, Zwolle, the Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; University Medical Center, University of Utrecht, Intensive Care Medicine, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - David Moolenaar
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Martini Hospital, Intensive Care Medicine, Groningen, the Netherlands
| | - Jan Jaap Spijkstra
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam UMC location Free University, Intensive Care Medicine, Boelelaan, 1117 Amsterdam, the Netherlands
| | - Ruud A L de Waal
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amphia Hospital, Intensive Care Medicine, Molengracht 21, 4818 CK Breda, the Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Intensive Care Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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McLarty J, Litton E, Beane A, Aryal D, Bailey M, Bendel S, Burghi G, Christensen S, Christiansen CF, Dongelmans DA, Fernandez AL, Ghose A, Hall R, Haniffa R, Hashmi M, Hashimoto S, Ichihara N, Kumar Tirupakuzhi Vijayaraghavan B, Lone NI, Arias López MDP, Mat Nor MB, Okamoto H, Priyadarshani D, Reinikainen M, Soares M, Pilcher D, Salluh J. Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study. Thorax 2024; 79:120-127. [PMID: 37225417 DOI: 10.1136/thorax-2022-219592] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. METHODS We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry. FINDINGS Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes. INTERPRETATION Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
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Affiliation(s)
- Joshua McLarty
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Edward Litton
- St John of God Hospital Subiaco, Perth, Western Australia, Australia
- The University of Western Australia School of Medicine and Pharmacology, Perth, Western Australia, Australia
| | - Abigail Beane
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | - Diptesh Aryal
- Nepal Intensive Care Research Foundation (NICRF), Kathmandu, Nepal
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Stepani Bendel
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | | | - Steffen Christensen
- Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Skejby, Denmark
| | | | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) foundation, Amsterdam, The Netherlands
| | - Ariel L Fernandez
- SATI-Q program, Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
| | - Aniruddha Ghose
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Ros Hall
- Public Health Scotland, Edinburgh, UK
| | - Rashan Haniffa
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Department of Clinical Medicine, University of Oxford Nuffield, Oxford, UK
| | | | - Satoru Hashimoto
- Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Japanese Intensive Care PAtient Database (JIPAD), Tokyo, Japan
| | | | | | - Nazir I Lone
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Maria Del Pilar Arias López
- Sociedad Argentina de Terapia Intensiva, Buenos Aires, Argentina
- PICU, Hospital de Ninos R Gutierres, Buenos Aires, Argentina
| | - Mohamed Basri Mat Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Matti Reinikainen
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland
- Department of Anaesthesiology and Intensive Care, University of Eastern Finland, Joensuu, Finland
| | - Marcio Soares
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - David Pilcher
- Alfred Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Jorge Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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5
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Salluh JIF, Quintairos A, Dongelmans DA, Aryal D, Bagshaw S, Beane A, Burghi G, López MDPA, Finazzi S, Guidet B, Hashimoto S, Ichihara N, Litton E, Lone NI, Pari V, Sendagire C, Vijayaraghavan BKT, Haniffa R, Pisani L, Pilcher D. National ICU Registries as Enablers of Clinical Research and Quality Improvement. Crit Care Med 2024; 52:125-135. [PMID: 37698452 DOI: 10.1097/ccm.0000000000006050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
OBJECTIVES Clinical quality registries (CQRs) have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. This narrative review describes the challenges, proposed solutions, and evidence generated by National ICU registries as facilitators for research and quality improvement. DATA SOURCES English language articles were identified in PubMed using phrases related to ICU registries, CQRs, outcomes, and case-mix. STUDY SELECTION Original research, review articles, letters, and commentaries, were considered. DATA EXTRACTION Data from relevant literature were identified, reviewed, and integrated into a concise narrative review. DATA SYNTHESIS CQRs have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. The initial experience in European countries and in Oceania ensured that through locally generated data, ICUs could assess their performances by using risk-adjusted measures and compare their results through fair and validated benchmarking metrics with other ICUs contributing to the CQR. The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs as well as their use in quality improvement studies, clinical trials as well as international comparisons, and benchmarking for ICUs. CONCLUSIONS ICU registries have provided increased knowledge of case-mix and outcomes of ICU patients based on real-world data and contributed to improve care delivery through quality improvement initiatives and trials. Recent increases in adoption of new technologies (i.e., cloud-based structures, artificial intelligence, machine learning) will ensure a broader and better use of data for epidemiology, healthcare policies, quality improvement, and clinical trials.
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Affiliation(s)
- Jorge I F Salluh
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Amanda Quintairos
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Department of Critical and Intensive Care Medicine, Academic Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Dave A Dongelmans
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
- National Intensive Care Evaluation (NICE) Foundation, Amsterdam, The Netherlands
| | - Diptesh Aryal
- National Coordinator, Nepal Intensive Care Research Foundation, Kathmandu, Nepal
| | - Sean Bagshaw
- Department of Medicine, Faculty of Medicine and Dentistry (Ling, Bagshaw), University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- Division of Internal Medicine (Villeneuve), Department of Critical Care Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta and Grey Nuns Hospitals, Edmonton, AB, Canada
| | - Abigail Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Maria Del Pilar Arias López
- Argentine Society of Intensive Care (SATI). SATI-Q Program, Buenos Aires, Argentina
- Intermediate Care Unit, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Argentina
| | - Stefano Finazzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Italy
- Associazione GiViTI, c/o Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Bertrand Guidet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, service de réanimation, Paris, France
| | - Satoru Hashimoto
- Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Edward Litton
- Fiona Stanley Hospital, Perth, WA
- The University of Western Australia, Perth, WA
| | - Nazir I Lone
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Intensive Care Society Audit Group, United Kingdom
| | - Vrindha Pari
- Chennai Critical Care Consultants, Pvt Ltd, Chennai, India
| | - Cornelius Sendagire
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
- Anesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Rashan Haniffa
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Crit Care Asia, Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Luigi Pisani
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
| | - David Pilcher
- University College Hospital, London, United Kingdom
- Department of Intensive Care, Alfred Health, Prahran, VIC, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Australia
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6
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Oyegbile YO, Brysiewicz P. Obtaining feedback from patients and their family in the emergency department. Afr J Emerg Med 2023; 13:177-182. [PMID: 37435362 PMCID: PMC10331413 DOI: 10.1016/j.afjem.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 05/16/2023] [Accepted: 06/04/2023] [Indexed: 07/13/2023] Open
Abstract
Obtaining feedback from the patient and their family members regarding their experience of the care they received in the emergency department is important. This provides an extremely valuable opportunity for healthcare professionals to assess the quality of care and serves to highlight any areas of weakness or strength in the care experience. Through a synthesis of available literature, this article describes the challenges in measuring such an experience especially in emergency departments in Africa, and outlines tools that are currently available in literature to measure the patient and family experience and or satisfaction. Implementation considerations are outlined in order to provide recommendations for emergency department healthcare professionals wanting to undertake such assessments.
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Affiliation(s)
- Yemisi Okikiade Oyegbile
- Department of Nursing, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Petra Brysiewicz
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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7
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Benchmarking of survival outcomes following Haematopoietic Stem Cell Transplantation (HSCT): an update of the ongoing project of the European Society for Blood and Marrow Transplantation (EBMT) and Joint Accreditation Committee of ISCT and EBMT (JACIE). Bone Marrow Transplant 2023:10.1038/s41409-023-01924-6. [PMID: 36894635 PMCID: PMC9995719 DOI: 10.1038/s41409-023-01924-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 03/11/2023]
Abstract
From 2016 EBMT and JACIE developed an international risk-adapted benchmarking program of haematopoietic stem cell transplant (HSCT) outcome to provide individual EBMT Centers with a means of quality-assuring the HSCT process and meeting FACT-JACIE accreditation requirements relating to 1-year survival outcomes. Informed by previous experience from Europe, North America and Australasia, the Clinical Outcomes Group (COG) established criteria for patient and Center selection, and a set of key clinical variables within a dedicated statistical model adapted to the capabilities of the EBMT Registry. The first phase of the project was launched in 2019 to test the acceptability of the benchmarking model through assessment of Centers' performance for 1-year data completeness and survival outcomes of autologous and allogeneic HSCT covering 2013-2016. A second phase was delivered in July 2021 covering 2015-2019 and including survival outcomes. Reports of individual Center performance were shared directly with local principal investigators and their responses were assimilated. The experience thus far has supported the feasibility, acceptability and reliability of the system as well as identifying its limitations. We provide a summary of experience and learning so far in this 'work in progress', as well as highlighting future challenges of delivering a modern, robust, data-complete, risk-adapted benchmarking program across new EBMT Registry systems.
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8
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Quintairos A, Pilcher D, Salluh JIF. ICU scoring systems. Intensive Care Med 2023; 49:223-225. [PMID: 36315260 PMCID: PMC9619008 DOI: 10.1007/s00134-022-06914-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Amanda Quintairos
- D'OR Institute for Research and Education, Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, 22281-100, Brazil
- Department of Critical and Intensive Care Medicine, Academic Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Prahran, VIC, 3004, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Australia
| | - Jorge I F Salluh
- D'OR Institute for Research and Education, Rua Diniz Cordeiro, 30 - 3º andar, Rio de Janeiro, RJ, 22281-100, Brazil.
- Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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9
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Raffa JD, Johnson AEW, O'Brien Z, Pollard TJ, Mark RG, Celi LA, Pilcher D, Badawi O. The authors reply. Crit Care Med 2022; 50:e801-e802. [PMID: 36227051 DOI: 10.1097/ccm.0000000000005648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Jesse D Raffa
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Alistair E W Johnson
- Peter Gilgan Center for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Tom J Pollard
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Roger G Mark
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Leo A Celi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
- Beth Israel Deaconess Medical Center, Boston, MA
| | - David Pilcher
- Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC, Australia
- Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Omar Badawi
- Medical Device Innovation Consortium, Arlington, VA
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10
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An exploration into physician and surgeon data sensemaking: a qualitative systematic review using thematic synthesis. BMC Med Inform Decis Mak 2022; 22:256. [PMID: 36171583 PMCID: PMC9520820 DOI: 10.1186/s12911-022-01997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Providing electronic health data to medical practitioners to reflect on their performance can lead to improved clinical performance and quality of care. Understanding the sensemaking process that is enacted when practitioners are presented with such data is vital to ensure an improvement in performance. Thus, the primary objective of this research was to explore physician and surgeon sensemaking when presented with electronic health data associated with their clinical performance. A systematic literature review was conducted to analyse qualitative research that explored physicians and surgeons experiences with electronic health data associated with their clinical performance published between January 2010 and March 2022. Included articles were assessed for quality, thematically synthesised, and discussed from the perspective of sensemaking. The initial search strategy for this review returned 8,829 articles that were screened at title and abstract level. Subsequent screening found 11 articles that met the eligibility criteria and were retained for analyses. Two articles met all of the standards within the chosen quality assessment (Standards for Reporting Qualitative Research, SRQR). Thematic synthesis generated five overarching themes: data communication, performance reflection, infrastructure, data quality, and risks. The confidence of such findings is reported using CERQual (Confidence in the Evidence from Reviews of Qualitative research). The way the data is communicated can impact sensemaking which has implications on what is learned and has impact on future performance. Many factors including data accuracy, validity, infrastructure, culture can also impact sensemaking and have ramifications on future practice. Providing data in order to support performance reflection is not without risks, both behavioural and affective. The latter of which can impact the practitioner's ability to effectively make sense of the data. An important consideration when data is presented with the intent to improve performance.Registration This systematic review was registered with Prospero, registration number: CRD42020197392.
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11
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Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, Beane A. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Res 2022; 6:251. [PMID: 35141427 PMCID: PMC8812332 DOI: 10.12688/wellcomeopenres.17122.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 02/02/2023] Open
Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings.
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Affiliation(s)
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand,Doctors with Africa CUAMM, Padova, Italy,
| | - Thalha Rashan
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Maryam Shamal
- NICS-MORU collaboration, Crit Care Asia Afghanistan team, Kabul, Afghanistan
| | - Aniruddha Ghose
- Department of Medicine, Chattogram Medical Centre, Chattogram, Bangladesh
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India,Chennai Critical Care Consultants, Chennai, India,Critical Care Medicine,, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Basri Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine,, International Islamic University Malaysia (IIUM), Kuala Lumpur, Malaysia
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
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Pisani L, Rashan T, Shamal M, Ghose A, Kumar Tirupakuzhi Vijayaraghavan B, Tripathy S, Aryal D, Hashmi M, Nor B, Lam Minh Y, Dondorp AM, Haniffa R, Beane A. Performance evaluation of a multinational data platform for critical care in Asia. Wellcome Open Res 2022; 6:251. [PMID: 35141427 PMCID: PMC8812332 DOI: 10.12688/wellcomeopenres.17122.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 02/02/2023] Open
Abstract
Background: The value of medical registries strongly depends on the quality of the data collected. This must be objectively measured before large clinical databases can be promoted for observational research, quality improvement, and clinical trials. We aimed to evaluate the quality of a multinational intensive care unit (ICU) network of registries of critically ill patients established in seven Asian low- and middle-income countries (LMICs). Methods: The Critical Care Asia federated registry platform enables ICUs to collect clinical, outcome and process data for aggregate and unit-level analysis. The evaluation used the standardised criteria of the Directory of Clinical Databases (DoCDat) and a framework for data quality assurance in medical registries. Six reviewers assessed structure, coverage, reliability and validity of the ICU registry data. Case mix and process measures on patient episodes from June to December 2020 were analysed. Results: Data on 20,507 consecutive patient episodes from 97 ICUs in Afghanistan, Bangladesh, India, Malaysia, Nepal, Pakistan and Vietnam were included. The quality level achieved according to the ten prespecified DoCDat criteria was high (average score 3.4 out of 4) as was the structural and organizational performance -- comparable to ICU registries in high-income countries. Identified strengths were types of variables included, reliability of coding, data completeness and validation. Potential improvements included extension of national coverage, optimization of recruitment completeness validation in all centers and the use of interobserver reliability checks. Conclusions: The Critical Care Asia platform evaluates well using standardised frameworks for data quality and equally to registries in resource-rich settings.
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Affiliation(s)
| | - Luigi Pisani
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand,Doctors with Africa CUAMM, Padova, Italy,
| | - Thalha Rashan
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Maryam Shamal
- NICS-MORU collaboration, Crit Care Asia Afghanistan team, Kabul, Afghanistan
| | - Aniruddha Ghose
- Department of Medicine, Chattogram Medical Centre, Chattogram, Bangladesh
| | - Bharath Kumar Tirupakuzhi Vijayaraghavan
- Indian Registry of IntenSive care, IRIS, Chennai, India,Chennai Critical Care Consultants, Chennai, India,Critical Care Medicine,, Apollo Hospitals, Chennai, India
| | - Swagata Tripathy
- Anaesthesia and Intensive Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Diptesh Aryal
- Critical Care and Anesthesia, Nepal Mediciti Hospital, Lalitpur, Nepal
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Pakistan
| | - Basri Nor
- Department of Anaesthesiology and Intensive Care, Kulliyyah (School) of Medicine,, International Islamic University Malaysia (IIUM), Kuala Lumpur, Malaysia
| | - Yen Lam Minh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Rashan Haniffa
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Abi Beane
- Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
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13
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Endacott R, Scholes J, Jones C, Boulanger C, Egerod I, Blot S, Iliopoulou K, Francois G, Latour J. Development of competencies for advanced nursing practice in intensive care units across Europe: A modified e-Delphi study. Intensive Crit Care Nurs 2022; 71:103239. [DOI: 10.1016/j.iccn.2022.103239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/21/2022]
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Stenger M, Jakobsen E, Wright G, Zalcberg J, Stirling RG. A comparison of outcomes and survival between Victoria and Denmark in lung cancer surgery: opportunities for international benchmarking. ANZ J Surg 2021; 92:1050-1055. [PMID: 34676962 DOI: 10.1111/ans.17302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Victoria (Australia) and Denmark have comparable population sizes and high-quality healthcare systems. Lung cancer surgery, however, is performed in more than 20 Victorian hospitals compared to four in Denmark. Such differences in centralization may influence outcomes. We engaged clinical quality registries to enable international benchmarking by exploring patterns of lung cancer surgery including mortality and survival. METHODS All patients undergoing lung cancer surgery between 2015 and 2018 registered in the Victorian Lung Cancer Registry and the Danish Lung Cancer Registry were included. Analyses on stage concordance, 30 and 90-day mortality, and overall survival were restricted to a selected subgroup with NSCLC and no neo-adjuvant therapy or metastatic disease and only one operation. RESULTS We included 1554 Victorian and 4319 Danish patients. The resection rate was 26.3% in Victoria and 28% in Denmark, but a higher proportion of Victorian patients underwent wedge resection (19.1% versus 8.8%). Stage concordance was 59.6% and 54.9% in Victoria and Denmark, respectively. The 30- and 90-day mortality was 1.3% and 2.6% in Victoria, compared to 1.4% and 2.8% in Denmark with no difference in overall survival (p = 0.28) or risk-adjusted survival (HR: 1.10 (95% CI: 0.89-1.37); p = 0.38). CONCLUSION High-quality surgical lung cancer care was confirmed by similar high resection and low mortality rates including no overall survival difference. The drivers and consequences of stage discordance and differences in patterns of resection deserve further exploration. This study provides a model for international benchmarking using clinical quality registries, although caution remains in the interpretation given disparities in data completeness.
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Affiliation(s)
- Michael Stenger
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Erik Jakobsen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Gavin Wright
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert G Stirling
- Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Minton C, Batten L, Best A. The long-term ICU patient: Which definition? J Clin Nurs 2021; 32:2933-2940. [PMID: 34723410 DOI: 10.1111/jocn.16078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To offer a review of the differing terminologies used by clinicians and researchers to describe the long-term intensive care unit (ICU) patient and the underlying propositions that align with this terminology. BACKGROUND Ongoing medical and technological advances in emergency and intensive care have resulted in improved survival of critically ill patients in recent decades. In addition, these advancements have also resulted in improved survival of complex critically ill patients who progress to a trajectory of prolonged critical illness, having protracted stays in the ICU. There is great variability in terminology used to define the long-term ICU patient. This lack of a common definition for long-term ICU patients is problematic, increasing their vulnerability and risk of care not being centred about their unique needs. DESIGN In this discursive article, we explore the terminology used to define the long-term ICU patient. An initial broad search of the literature across four electronic databases was conducted to identify common terminology used to define the long-term ICU patient. From here, seven definitions were identified and chosen for inclusion in the review as they meet inclusion criteria and clearly described a group of patients who have an extended ICU stay. The seven selected terms are as follows: prolonged mechanical ventilation; failure to wean; insertion of tracheostomy; chronically critically ill; persistent critical illness; persistent inflammatory-immunosuppressive and catabolic syndrome; and frailty. Following this a focused review of the literature with the selected terms was conducted to explore in greater detail the terminology. DISCUSSION The lack of clear definition for this patient group can potentiate their care needs being unmet. Acknowledgement of the need to clearly define this patient group is the first step to improve outcomes. Nursing is well positioned to recognise the different terminologies use to describe this group of patients and implement care to suit their unique clinical characteristics. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE Recognition and standardisation of these terms are an important priority to pave the way to improve care pathways and outcomes for this group of patients and their family.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Lesley Batten
- College of Health, Massey University, Palmerston North, New Zealand
| | - Amy Best
- School of Nursing, Massey University, Wellington, New Zealand
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17
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Peres IT, Hamacher S, Oliveira FLC, Bozza FA, Salluh JIF. Prediction of intensive care units length of stay: a concise review. Rev Bras Ter Intensiva 2021; 33:183-187. [PMID: 34231798 PMCID: PMC8275087 DOI: 10.5935/0103-507x.20210025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/10/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Igor Tona Peres
- Departamento de Engenharia Industrial, Pontifícia Universidade Católica do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Silvio Hamacher
- Departamento de Engenharia Industrial, Pontifícia Universidade Católica do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Fernando Luiz Cyrino Oliveira
- Departamento de Engenharia Industrial, Pontifícia Universidade Católica do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Fernando Augusto Bozza
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil
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Haniffa R. Future perspectives for Clinical Quality Registries in critical care. J Crit Care 2020; 63:279. [PMID: 33309431 DOI: 10.1016/j.jcrc.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/03/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Rashan Haniffa
- Crit Care Asia, Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka; Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand; Centre for Tropical Medicine and Global Health, University of Oxford, UK; University College Hospital, London, UK.
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