Gudivada Kiran Kumar, Krishna Bhuvana, Sriram Sampath
Department of Critical Care Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.
Indian J Crit Care Med. 2017 Dec;21(12):841-846. doi: 10.4103/ijccm.IJCCM_303_17.
Quality indicators (QIs) are essential for maintaining quality of care in the critically ill. The Indian Society of Critical Care Medicine proposed benchmarks and enabled Indian Intensive Care Units (ICUs) to capture data in an electronic database: Customized Health in Intensive Care Trainable Research and Analysis (CHITRA) tool. The purpose of this study is to report QIs in an Indian ICU using this database.
Data from patients admitted to ICU between October 2015 and January 2017 were entered into CHITRA. The following QIs were analyzed: standardized mortality ratio (SMR), length of ICU stay (LOS-ICU), pressure ulcer (PU) rate, patient fall rate (FR), ICU readmission rate, reintubation rate, ventilator-associated condition (VAC), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and iatrogenic pneumothorax rate.
A total of 2642 patient's information was suitable for analysis. Median age of ICU admission was 53 years (interquartile range [IQR]: 36-65), with a mean APACHE score of 18 (SD 7.7). Median LOS-ICU was 3 days (IQR 2-6) and SMR was 1.1 (95% confidence interval 1.05-1.38). Pneumothorax rate, PU rate, and FR were 2.6, 4.1, and 0.3 per 1000 respectively, whereas readmission rate was 0.7% and reintubation rate was 3.5%. VAC, CLABSI, and CAUTI were 8.5, 23, 3.1 per 1000 ventilator and catheter days, respectively.
This study has successfully evaluated a range of QIs in a mixed ICU of a tertiary hospital utilizing CHITRA database.
质量指标对于维持重症患者的医疗质量至关重要。印度重症医学学会提出了基准,并使印度重症监护病房(ICU)能够在电子数据库中收集数据:重症监护可训练研究与分析定制健康(CHITRA)工具。本研究的目的是使用该数据库报告印度一家ICU的质量指标。
将2015年10月至2017年1月入住ICU的患者数据录入CHITRA。分析了以下质量指标:标准化死亡率(SMR)、ICU住院时间(LOS-ICU)、压疮(PU)发生率、患者跌倒率(FR)、ICU再入院率、再次插管率、呼吸机相关状况(VAC)、中心静脉导管相关血流感染(CLABSI)、导尿管相关尿路感染(CAUTI)和医源性气胸发生率。
共有2642例患者的信息适合分析。ICU入院患者的中位年龄为53岁(四分位间距[IQR]:36-65),急性生理与慢性健康状况评分系统(APACHE)平均评分为18分(标准差7.7)。ICU住院时间中位数为3天(IQR 2-6),标准化死亡率为1.1(95%置信区间1.05-1.38)。气胸发生率、压疮发生率和跌倒率分别为每1000例2.6、4.1和0.3例,而再入院率为0.7%,再次插管率为3.5%。呼吸机相关状况、中心静脉导管相关血流感染和导尿管相关尿路感染分别为每1000呼吸机日和导管日8.5、23、3.1例。
本研究利用CHITRA数据库成功评估了一家三级医院混合ICU中的一系列质量指标。