Quality Improvement examples
Examples of where the audit has contributed to Quality Improvement in critical care
HAI Surveillance and Improvement
Improvement has been seen over recent years in the number of units that now participate in HAI surveillance.
From 2013 data 96% of ICUs participate fully according to SICSAG QI standards in HAI surveillance and 93% of HDU units do so partially (monitor Staphylococcus aureus bacteremia (SAB) only). As such we have been able to demonstrate a significant reduction in the percentage of patients who developed an HAI from 4.7% in 2011 to 3.4% in 2012.
Standardised Mortality Ratio (SMR)
The Standardised Mortality Ratio (SMR) where actual mortality is compared with expected mortality, using APACHE II methodology. This allows a better comparison of mortality over time and between different units, as illness severity and case-mix are adjusted for.
SICSAG has demonstrated that, with the exception of 2009, the SMR across Scotland has fallen during the period 2004 – 2012. The APACHE II scoring system is over 30 years old and may not reflect current ICU practice and case-mix. For this reason APACHE II was recalibrated in 2012 using Scottish data from 2009-2011, then tested on Scottish data from 2007-2008.
From 2012 to 2013 the standard and recalibrated SMR remained the same at 0.75 and 0.90 respectively.
Good practice from one area has been adopted in another.
Tracheostomy safety documentation that was developed in Ninewells ICU has been shared around the critical care community through the SICSAG network and is now used in several different ICUs in the west of Scotland.
With the critical care trainees completing their tracheotomy study with SICSAG data this year (to be presented at 2015 annual conference) this is expected to add power to the growing body of evidence of excellence in the care of tracheostomy patients in critical care that can be shared around the critical care community via the SICSAG network.