Sudden increase in ICU-mortality rate: a look behind the stage applying continuous quality improvement

Continuous quality improvement (CQI) implies regular evaluation of and reaction to a variety of parameters (`indicators'). We examined 238 consecutive patients admitted to our newly chaired 8-bed medical ICU in 1995 in terms of severity of organ failure at admission, mortality rate (MR%), and the relation of ventilator therapy (VD) for survivors (S) versus non-survivors (N), and compared the results with our patients of 1994 (n = 215) as well as, prospectively, with all consecutive patients of 1996.

Results

See table.

ICU-MR as well as the VD for non-survivors increased (31% to 56%) during 1995. In search for the cause of this finding the incidence of three- and four-organ failure at admission was found to be elevated. These effects were reversible during the first 9 months of 1996.

Conclusions

(i) The increase in MR was due to a significant change in case mix (more frequent admission of patients with late-stage-MOF including liver failure and extremely poor prognosis) during 1995 rather than to improper therapeutic skills of personnel. (ii) This increased long-term supply of life-support (VD) for patients with poor prognosis. (iii) Revision of admission policy and information campaigns referring to manage organ failure in earlier stages were able to reverse our efficiency to the original extent.

Table