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Four-dimensional approach to quality and performance of intensive care: rapid routine overview of performance by derived indexes


The quality of intensive care (QIC) can be defined by several dimensions: structure, process and outcomes [1]. All Finnish ICUs contribute to the Finnish Intensive Care Quality Consortium (FICQC) with shared reports over the Internet. The FICQC chose to describe the quality of intensive care by four dimensions: patient outcome, patient selection, resource utilization and data completeness. The aim of this work was to develop a continuous, comprehensive and compact view of the quality of intensive care and to describe the effects of organizational changes on the performance.


The four most significant dimensions and elements for each dimension were selected by an expert panel (Figure 1). Briefly on the elements of each dimension: Outcome describes patient survival after the ICU stay; Patient selection consists of the ratio of high-risk patients to low-risk patients; Resource utilization indicates ICU productivity and use of resources; and Data completeness describes the missing data ratio. Data completeness indicates also the quality of data collection and recording procedures. Element values are weighed by arbitrarily defined coefficients and the dimension scores are calculated. Dimension scores are adjusted with a data transformation algorithm to index values. Indexes are reported every 3 months as part of FICQC routine reporting.

Figure 1
figure 1

Four fundamental dimensions of the quality of intensive care.


Members of the FICQC see the indexes as a valuable reporting method. Organizational changes are reflected in the indexes. Examples will be shown.


Quality indexes are powerful when defined and designed properly. The indexes provide the user with a rapid, comprehensive view of performance in a compact format. The indexes help the ICU management to monitor and thereby even improve the unit's performance and quality.


  1. Curtis , et al.: Intensive care unit quality improvement: a how-to guide for the interdisciplinary team. Crit Care Med 2006, 34: 211-218. 10.1097/01.CCM.0000190617.76104.AC

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Mussalo, P., Tenhunen, J. Four-dimensional approach to quality and performance of intensive care: rapid routine overview of performance by derived indexes. Crit Care 12 (Suppl 2), P431 (2008).

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