Managing performance in the intensive care unit: a new system in Brazil

Objective

The study of the performance of one ICU is still setting up. There is no consensus about criteria to guarantee quality. To analyse the performance of an ICU and to benchmark it with other ICUs could be a valuable experience. The objective was to study the performance of one ICU and, for benchmarking proposes, to compare it with itself and against a standard composed of seven other ICUs. The name of this system is QuaTI, a Brazilian small animal; the name remembers the word quality (qualidade, in Portuguese).

Materials and methods

A group of intensivists supported by a Brazilian producer of medical equipment (Dixtal) have created a computer program that collects many variables that compose the idea of performance.

We register, on a daily basis, variation of the data studied, the mean value, the mean value of benchmarking (the same subject in other ICUs), and control graphics (with upper limit and lower limit of control covering a confidence interval of 95%). This information is in one ICU computer covering a period of 16 weeks; every 3 months we receive a report with more complete analyses, and after 12 months there is a special report with consolidated information. The data are divided into management, clinical and risk indicators. Each group of indicators are composed of some data; for example, risk indicators are composed of the rate of patients with some infection, rate of accidental extubation, rate of pneumothorax by barotraumas, rate of pneumothorax by venous puncture, and rate of pressure ulcers. The system has confidentiality, so you only know your data and the benchmarking, but not the data from one specific ICU. The databank is the domain of AMIB (Brazilian Society of Intensive Medicine). We start using QuaTI at the end of 2001. There were 30 ICUs in the system at the end of 2002 and 56 at the end of 2003.

Results

We could compare the performance of our ICU with ourselves along time, every 3 months, each year and with data from benchmark ICUs. With this information we know our comparative performance and we can decide whether it is necessary to change some processes on a real and comparative basis.

Conclusion

The study of the performance of one ICU is difficult, complex and expensive. The better 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.