Critical care is delivered by a multidisciplinary team led by a consultant in intensive care medicine working in a well-equipped and appropriately designed environment. The Core Standards for Intensive Care Units (opens PDF, 1.32MB, published by the Faculty of Intensive Care Medicine and the Intensive Care Society, 2013) underpin the delivery of a high-quality service.
A closed model of care, in which patients admitted to the ICU are transferred to the care of an intensive care medicine physician assigned to the ICU on a full-time bases is associated with reduced mortality and morbidity, as described here.
All critical care services should collect standardised national data through a recognised national clinical audit, such as ICNARC’s Case Mix Programme (CMP) or the Scottish Intensive Society Audit Group (SICSAG). These audits collect comprehensive individual patient data that allows the calculation of case mix adjusted predicted outcome. Units receive regular comprehensive reports of their activity and outcomes including standardized mortality ratios benchmarked to the national average. ICNARC publish an annual report including a number of quality outcome indicators for all participating units.
All Units should have regular multiprofessional clincial governance meetings to review patient morbidity and mortality.
The use of guidelines and care delivery bundles is encouraged to assist the delivery of a consistent high quality and evidence based service. One such example of a care bundle is the one for improving severe sepsis management.
A number of key quality indicators for delivery of critical care have been described:
- Cancelled elective surgery due to lack of critical care beds (opens PDF, 269.71KB)
- Delayed emergency admission
- Discharges from ICU out of hours (2200–0800)
- ICU readmission rate (within 48 hours of discharge)
- Application of lung protective ventilation
- Rate of nosocomial infections (ventilator associated pneumonia and central line related infections)
- Acquisition of skin pressure injury.