Quality assurance in Intensive Care

Quality assurance in intensive care came up in Question 2a from the first paper of 2001, which throws the candidate into the position of unit director, and then demands they establish a quality assurance program. The brevity of the college answer demonstrates that even the examiners could not bring themselves to behold this tedious topic in any great detail.

Fortunately, CICM have (on their own website) an article by L.I. Worthley on this very topic. Given that an examiner wrote the article, one might expect it to contain some material relevant to this question.

In addition, one can find a NSW Health policy document which provides some information about what a quality assurance program should look like. However, the most relevant document turned out to be this review article from Crit Care Med (2006)

The following points have been compiled from this article, and several others.

Preparation of a quality assurance project:

• Identify critical areas of interest and collect data about meaningful outcomes.
• Prioritise potential projects
• Prepare a plan for the identified projects, with a task list, budget considerations, a timeline, and clearly defined leadership with central reporting
• Clearly define the measured variables
• Assess the logistics of collecting this data
• Create a data collection system, eg. a regularly maintained database of adverse events

Collection of quality data

• Assess the current quality of care using the established data collection methods
• Morbidity and mortality data collection
• Incident monitoring
• Patient and family satisfaction surveys
• Staff satisfaction surveys
• Feedback from external non-ICU services and prehospital staff

Assessment of quality data

• Morbidity and mortality audit - regulargly
• Incident review meetings - regularly
• Encourage the attendance and contribution from all staff

Generation of recommendations

• Evidence-centered literature search for solutions to identified problems
• Consultation with relevant specialists and with local medical staff
• Evaluation of evidence-based recommendations for improvement, and their cost-benefit analsysis
• Assessment of the tolerability of their implementations, the logistics of this and changes to funding.
• The presentation of recommendations at department meetings to encourage discussion

Monitoring and audit

• Ongoing data collection
• Regular review of outcome trends and assessment of effective and ineffective QA strategies

Structure of the QA program

• Education of all staff to be involved in incident reporting
• Specific staff groups responsible for data colelction
• Specific staff allocated the task of ensuring high data quality
• A leader for the project, who reports to the head of department
• Data entry and database maintenance staff