Quality in the intensive care unit: a general intensive care unit compared with a cardiointensive unit

Objectives

Nowadays, to improve quality is not only a challenge, but a question of survival of an institution. There is no consensus how to study quality in ICU. The objective was to study the evolution of some variables that could improve outcome. The name of the system is QuaTI, a Brazilian small animal; the name remembers the word quality (qualidade, in Portuguese). We compared a general ICU with a cardiointensive unit (CIU).

Materials and methods

The period of study was January–October 2004. We studied, on a monthly basis, the following variables: age, sex, length of stay in ICU (LOS), occupation rate (OR), real mortality rate, invasive mechanical ventilation rate, accidental extubation, pneumothorax by accidental punction and pressure ulcers and casemix. We compared the results of a general ICU with a cardiointensive ICU.

Results

Our data are: age ICU = 60.6 years old vs CIU = 62.4 years old; sex ICU male = 53% vs CIU = 61.8%; LOS ICU = 5.3 vs CIU = 3.8; OR: ICU = 93% vs CIU = 96%; real mortality rate ICU = 14.5% vs CIU = 3,6%; invasive mechanical ventilation ICU = 25.6% vs CIU = 17.3%; accidental extubation ICU = 1.4% vs B (CIU) = 0.8%; pneumothorax by accidental punction HCN (ICU) = 2.8 vs CIU = 0; and pressure ulcers HCN (ICU) = 3.7% vs CIU = 0.5; the casemix in the ICU was 33.3% neurologic, 19.4% respiratory and 15.6% cardiovascular, and in the CIU the casemix was 77.2% cardiovascular, 8.5% neurologic and 5.1% respiratory.

Conclusion

The study of the performance of one ICU is difficult, complex and expensive. The best way to know one specific performance is to compare it with similar ICUs that have similar resources and casemix. To compare a Brazilian ICU with a European or American ICU is not ideal and could give equivocal information that generates erroneous decisions. With QuaTI, we begin a very interesting project that will create a Brazilian databank on ICU performance.

In our study, the main difference is the casemix, with much more neurologic cases in the ICU versus the CIU where predominant is cardiovascular, 77.2%. The outcome of mortality is completely different – 14.5% versus 3.6%. Our worse rates as pressure ulcers could be explained by the casemix (more neurologic patients), and the difference among the pneumothorax is explained because in a CIU we usually do not make profound venous access. The main importance is to have data and establish strategies for improved quality and safety. The QuaTI works in this direction.