critical care network: critical care database (in bc) - measurement for improvement, operations and...
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Critical Care DatabaseCritical Care Database(in B.C.)(in B.C.)
Measurement for Operations, Measurement for Operations, Improvement, and ResearchImprovement, and Research
History and Current UsersDate Site
1997/98 Joint development by SPH, VGH, Victoria ICU physicians
1999 PHC: St. Paul’s Hospital
2000 VCHA: Vancouver General Hospital
2002 Richmond Hospital
2005 Lion’s Gate Hospital
2006 Mount St. Joseph
2006 FRASER HEALTH: Royal Columbian, Surrey, Burnaby, Peace Arch
2008 Powell River (1-year); Royal Columbian Hospital High Acuity Unit
February 2009 Abbotsford, Langley, Chilliwack, Ridge Meadows
August 2009 NORTHERN HEALTH: Prince George
Structure• Oracle platform• Web-based (no copy of database on local computers)
• Use of existing standard nomenclature/labels:
– Diagnoses: ICNARC and APACHE
– Services: CIHI
• Explicit definitions of all fields:
– eg. procedures, elements of severity scores, safety
outcomes
Privacy • Database housed on PHC server within CHEOS• Site-specific view – can access and view patients’ files specific
to own ICU only• 2 levels of sign-on authentication (unique password for each
user)• Forced requirement to change password on a regular basis• Failed attempts & “idle” time = lock out• Encrypted data transfer• Ability to audit database access (by date & user
authentication)• Privacy Impact Assessment completed
Database ContentDemographics,
Visit information (ICU & Hospital)
Admission InformationDischarge Information
Outcomes
DiagnosesInterventions
Arterial & Central Lines
Severity of Illness:Apache IIApache IV
SOFA
Level of CareOverflow
Avoidable Days
MinimumDataset
Patient Safety Measures:•Clostridium Difficile
•Hypoglycemic Events•Major Bleeds (on anticoagulants)
•Central Venous catheter associated bloodstream
infections•Unplanned extubations
•Suspected Ventilator-associated pneumonia
Vasoactive Drugs
Blood Products
RASS (sedation score)Delirium score
TRISS (VGH only)
Optional Dataset
Many Uses for the ICU Database• Describe clinical care—processes and outcomes• Utilization management—occupancy, volume of
activity• Patient Quality & Safety Initiatives• Internal/external performance indicators• Management of staff• Measure effects of changes in care• Planning• Collaboration with others• Research (approval and ethics)
7
VGH ICU Admissions: 11 – Year Summary
Occupancy and Patient-Days--SPH
10
VGH ICU Occupancy Based on ICU Database vs. census at midnight vs. census at noon
0
5
10
15
20
25
30
35
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ICU
Bed
s U
tili
zed
January 2010
Census at 12 noon Census at 12 midnight
Levels of Care--SPH
Aging Population
Distribution of ICU Diagnoses
Admission Times--VGH
Discharge Times--VGH
? Delayed ICU care?
5.9 6.9 8.4
20
24
32
0
5
10
15
20
25
30
35
40
45
24 hours 2-7 days > 8 days
Hospital Mortality
LOS
Effect of Critical Care Outreach Team
Some Recent Research ProjectsSome Recent Research Projects• Variation in length of ICU stay after cardiac arrest: where you are is as
important as who you are. Critical Care Medicine. 2007; 35: 836-841.
• Pneumothorax After Insertion of Central Venous Catheters in the Intensive Care Unit: Association with Month of Year and Week of Month. Quality and Safety in Health Care, 2007 16: 252-255
• Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent. Chest. 2008; 134: 1217-1222.
• Reliability of ICU Admitting and Comorbid Diagnoses, Race, Elements of APACHE II Score, and Predicted Probability of Mortality in an Electronic ICU Database. Journal of Critical Care. 2009; 24: 401-407.
• Introduction of a comprehensive management protocol for severe sepsis is associated with sustained improvements in timeliness of care and survival. Quality and Safety in Health Care. 2010; 19: 1-7.
• Nursing Work Schedules and the Risk of Hypoglycemia in Critically Ill Patients Receiving Intravenous Insulin. Quality and Safety in Health Care 2010; 19: 1-4.
Involvement with OthersInvolvement with Others
• Canadian Critical Care Vital Signs Monitor (CCVSM)
– Web-based national ICU reporting system since 2008
– 24 sites in 5 provinces
– 20 indicators
– Data are stratified and reported according to peer group: academic/teaching, medical, surgical, trauma, cardiovascular
• Canadian Critical Care Trials Group—Knowledge Translation Network (coming soon)
The Future• Measurement to improve all dimensions of Measurement to improve all dimensions of
qualityquality• Integration
– Within institutions– Between institutions– Within regions– Between regions– Provincial—a critical care system
• ‘‘Backbone’ for a community of practice among Backbone’ for a community of practice among ICU personnel in B.C. (and across Canada)ICU personnel in B.C. (and across Canada)
Screen Shots
Severity of Illness Measures
Optional Data Screens