Impact of an accreditation process in a surgical ICU

Background

Accreditation has been generally viewed as a desirable process to establish standards and work toward achieving higher quality medical care. The worldwide emphasis on accountability has stimulated dramatic growth in internal quality management programs, external benchmarking with comparative data and accreditation for healthcare facilities. There are few published data about the effects of an accreditation process on ICU performance. The aim of this study was to describe the effects of an accreditation process in a surgical ICU.

Methods

In this retrospective cohort study we considered two different periods, the first one (October 2003–September 2004) as the pre-accreditation (PA) period and the second one (October 2004–September 2005) as the accreditation period (A). We obtained demographic data, APACHE II score, ICU-mortality rate, LOS, ICU-acquired infection rate, invasive procedure-related complication rate and number of training hours per staff member. We compared these variables between the PA and A periods using the Wilcoxon test.

Results

We included 784 patients in the study: 426 in the PA period and 358 in the A period. As shown in Table 1 although we observed a statistical significant increase in APACHE II score and LOS we were unable to demonstrate any difference in the other variables between the periods. Also we could observe a trend toward increasing training hours per staff member as a possible benefit from an accreditation process.

Table 1

Conclusion

Based on these preliminary data we were unable to demonstrate any benefit from the implementation of accreditation standards in ICU routine daily practice. A trend toward increasing training hours could be observed. Whether an accreditation process has a positive impact on ICU performance is a question that remains to be answered.