Validating a process-of-care checklist for intensive care units.

Early evidence suggests that checklists are one way of ensuring required processes of care are delivered to intensive care unit patients. Evidence to date however, has not explicitly detailed methods of checklist validation in these settings. This study aimed to test the validity of a 'process-of-care' checklist for measuring and ensuring daily care delivery in an intensive care unit. A retrospective audit of a random selection of patient medical records was undertaken to compare with checklist data completed during the same time frame. Documentation in the patients' medical records was used as a proxy measure for actual completion of care. A specific audit tool extracted information from both the checklist and the medical record on the following processes of care: nutrition, weaning from ventilation, pain, glucose control, sit out of bed, bowel management, deep vein thrombosis and stress ulcer prophylaxis. These two data sources were compared using the Spearman's rho correlation coefficient. The two forms of documentation were significantly correlated (P=0.01) for all but one of the checklist items (pain). Findings provided support for the concurrent validity of an intensive care unit process-of-care checklist. Further research is required for checklist validity and reliability testing prior to, or in conjunction with, a planned prospective intervention study.

Assessment and perceptions of intensive care data quality, reporting and use: a survey of ICU directors.

It is becoming increasingly common for government bodies, healthcare providers, funders and consumers to seek measures of the quality of critical care. It is important to ensure the quality of intensive care unit (ICU) data is high so these stakeholders can confidently use quality of care measures in decision-making. This paper aims to evaluate the quality of data collected for and submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, and to investigate the perceptions of NSW ICU directors in relation to ICU data quality, reporting and usage. A survey tool was developed based on an existing framework that consisted of procedures for assessing data quality in medical registries. The survey was distributed to the directors of all NSW ICUs that submitted data in the 2007/2008 financial year. Overall, completeness of the data and its quality was perceived to be good. Participants were less likely to engage in activities involving the detection and correction of data errors, feedback of data or use of data for local purposes. A number of barriers and enablers to good quality ICU data as well as strategies to improve data quality were identified. Inadequate staff, training and resources for data collection were widespread concerns. NSW ICU directors believe more work is required to achieve high quality data and appropriate use of the data collected. Strategies targeting increased resources including updated technology and improved staffing and training, as well as low-cost solutions such as audit, feedback and clinician engagement, have been highlighted.

Compliance with processes of care in intensive care units in Australia and New Zealand--a point prevalence study.

There are indications that compliance with routine clinical practices in intensive care units (ICU) varies widely internationally, but it is currently unknown whether this is the case throughout Australia and New Zealand. A one-day point prevalence study measured the prevalence of routine care processes being delivered in Australian and New Zealand ICUs including the assessment and/or management of: nutrition, pain, sedation, weaning from mechanical ventilation, head of bed elevation, deep venous thrombosis prophylaxis, stress ulcer prophylaxis, blood glucose, pressure areas and bowel action. Using a sample of 50 adult ICUs, prevalence data were collected for 662 patients with a median age of 65 years and a median Acute Physiology and Chronic Health Evaluation II score of 18. Wide variations in compliance were evident in several care components including: assessment of nutritional goals (74%, interquartile range [IQR] 51 to 89%), pain score (35%, IQR 17 to 62%), sedation score (89%, IQR 50 to 100%); care of ventilated patients e.g. head of bed elevation > 30 degrees (33%, IQR 7 to 62%) and setting weaning plans (50%, IQR 28 to 78%); pressure area risk assessment (78%, IQR 18 to 100%) and constipation management plan (43%, IQR 6 to 87%). Care components that were delivered more consistently included nutrition delivery (100%, IQR 100 to 100%), deep venous thrombosis (96%, IQR 89 to 100%) and stress ulcer (90%, IQR 78 to 100%) prophylaxis, and checking blood sugar levels (93%, IQR 88 to 100%). This point prevalence study demonstrated variability in the delivery of 'routine' cares in Australian and New Zealand ICUs. This may be driven in part by lack of consensus on what is best practice in intensive care units, prompting the need for further research in this area.

Cardiac arrest in Saudi Arabia: a 7-year experience in Riyadh.

All out-of-hospital and Emergency Department (ED) cardiac arrests treated at a tertiary care hospital in Riyadh, Saudi Arabia, from 1989 through 1995 were studied. Of patients arresting out-of-hospital, 3.0% received bystander cardiopulmonary resuscitation (CPR), 9.1% had some prehospital CPR, 12.1% were transported via ambulance, and 13.6% had ventricular fibrillation (VF) on ED arrival. In the witnessed arrests (80%), the estimated interval from arrest to initiation of CPR was 21.1 +/- 14.7 min. None of these variables was shown to influence outcome. Survival to hospital discharge from out-of-hospital arrest was 5.1% for adults and 7.4% for children; all had poor neurologic outcome. For patients arresting in the ED, an initial rhythm of ventricular tachycardia (VT) or VF was strongly correlated with survival. Survival from ED arrest was 30.4% in adults, 42.9% in children; all but one had normal neurologic outcome. These results are similar to those reported from large cities and EDs elsewhere. The unique set of variables influencing out-of-hospital care and transportation in Riyadh are discussed, and potential areas for improvement are noted.