Quality of care on an intensive care unit: using subjective indicators as an analysis tool

Introduction

The routine follow-up of objective quality indicators (product analysis) and subjective quality indicators (service analysis) has essential importance to adequate management of an ICU. It allows continuous PDCA cycles (to plan, to do, to check and to act) and the adoption of preventive and corrective measures, which is a simple, dynamic and efficient management system.

Patients and methods

We applied satisfaction questionnaries to patients admitted from February to November 2003 and their relatives. These questionaries generated the Patient Satisfaction Index (PSI) and the Relative Satisfaction Index (RSI), by means of the 17 patients' answers and 10 relatives' answers. The statistical analysis used: Mann–Whitney test (to compare two groups in which variables did not present a normal distribution), Kruskal–Wallis analysis of variance (to compare three or more groups), chi-squared test (to compare qualitative data between each 5-month period), and Pearson coefficient (to measure the correlation strength between PSI and RSI). We accepted P < 0.005 as significance level. The software pack used was the SAS^® system.

Results

Indexes general descriptive analysis: PSI 2.856 (mean value), RSI 2.882 (mean value). PSI descriptive and statistical analysis by month: no difference (P = 0.10). RSI descriptive and statistical analysis by month: no difference (P = 0.005). PSI descriptive and statistical analysis by 5-month period: no difference (P = 0.31). RSI descriptive and statistical analysis by 5-month period: no difference (P = 0.65). Correlation coefficient between PSI and RSI: positive correlation (P = 0.0001 r = 0.516).

Conclusions

Our management system was good in services issue because: (1) the PSI mean was 2.856 and the RSI was 2.882 – both above 2.5, our initial goal; (2) there was no significative variance in the PSI between the months, which indicates a uniform behavior of the service; (3) there was no significative difference in the PSI and RSI measures between both 5-month periods, which shows uniformity in the offered services; and (4) there was strong association between PSI and RSI, which confirms that the ICU team really sees patients' relatives like clients, which means a good quality of service.