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ICU quality and management tools - Wikipedia
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<h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">ICU quality and management tools</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="This article exist only in this language. 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data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Essay-like plainlinks metadata ambox ambox-style ambox-essay-like" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/40px-Edit-clear.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/60px-Edit-clear.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/f/f2/Edit-clear.svg/80px-Edit-clear.svg.png 2x" data-file-width="48" data-file-height="48" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This article <b>is written like a <a href="/wiki/Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_a_publisher_of_original_thought" title="Wikipedia:What Wikipedia is not">personal reflection, personal essay, or argumentative essay</a></b> that states a Wikipedia editor's personal feelings or presents an original argument about a topic.<span class="hide-when-compact"> Please <a class="external text" href="https://en.wikipedia.org/w/index.php?title=ICU_quality_and_management_tools&action=edit">help improve it</a> by rewriting it in an <a href="/wiki/Wikipedia:Writing_better_articles#Information_style_and_tone" title="Wikipedia:Writing better articles">encyclopedic style</a>.</span> <span class="date-container"><i>(<span class="date">September 2008</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>The <a href="/wiki/Intensive_care_unit" title="Intensive care unit">intensive care unit</a> (ICU) is one of the major components of the current health care system. The advances in supportive care and monitoring resulted in significant improvements in the care of surgical and clinical patients. Nowadays aggressive surgical therapies as well as transplantation are made safer by the monitoring in a closed environment, the surgical ICU, in the post-operative period. Moreover, the care and full recovery of many severely ill clinical patients as those with life-threatening infections occurs as a result of medical intensive care unit. </p><p>However, despite many significant advances in various fields as <a href="/wiki/Mechanical_ventilation" title="Mechanical ventilation">mechanical ventilation</a>, renal replacement therapy, antimicrobial therapy and hemodynamic monitoring this increased knowledge and the wise use of such technology is not available for all patients. Shortage of ICU beds are an important issue, however even when ICU beds are available significant variability in treatment and in the adherence to evidence-based interventions do not occur. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Tools_for_ICU_quality_monitoring">Tools for ICU quality monitoring</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=ICU_quality_and_management_tools&action=edit&section=1" title="Edit section: Tools for ICU quality monitoring"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Several measures of ICU performance have been proposed in the past 30 years. It is intuitive, and correct, to assume that ICU mortality may be a useful marker of quality. However, crude mortality rates does not take into consideration the singular aspects of each specific patient population that is treated in a certain geographic region, hospital or ICU. Therefore, approaches looking for standardized mortality ratios that are adjusted for disease severity, comorbidities and other clinical aspects are often sought. Severity of illness is usually evaluated by scoring systems that integrates clinical, physiologic and demographic variables. Scoring systems are interesting tools to describe ICU populations and explain their different outcomes. The most frequently used are the <a href="/wiki/APACHE_II" title="APACHE II">APACHE II</a>, <a href="/wiki/SAPS_II" title="SAPS II">SAPS II</a> and MPM. The <a href="/wiki/APACHE_II" title="APACHE II">APACHE II</a>, for example, provides an estimate of ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account. The data used should be from the initial 24 hours in the ICU, and the worst value (furthest from baseline/normal) should be used. The <a href="/wiki/APACHE_II" title="APACHE II">APACHE II</a> can also define "chronic organ insufficiency" - including liver, cardiovascular, respiratory and renal- as well as defining when a patient is immunocompromised. However, newer scores as APACHE IV and <a href="/wiki/SAPS_III" title="SAPS III">SAPS III</a> have been recently introduced in clinical practice. More than only using scoring systems, one should search for a high rate of adherence to clinically effective interventions. Adherence to interventions as deep venous thrombosis prophylaxis, reduction of ICU-acquired infections, adequate sedation regimens and decreasing and reporting serious adverse events are essential and have been accepted as benchmarking of quality. </p><p>The complex task of collecting and analyzing data on performance measures are made easier when clinical information systems are available. Although several clinical information systems focus on important aspects as computerized physician order entry systems and individual patient tracking information, few have attempted to gather clinical information generating full reports that provide a panorama of the ICU performance and detailed data on several domains as mortality, length of stay, severity of illness, clinical scores, nosocomial infections, adverse events and adherence to good clinical practice. Through implementing quality initiatives, increasing the quality of care and patient safety are major and feasible goals. Such systems (for example: <a rel="nofollow" class="external text" href="http://www.epimedsolutions.com/index.php?lang=english">Epimed Monitor</a>) are available for clinical use and may facilitate the process of care on a daily basis and provide data for an in-depth analysis of ICU performance. </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=ICU_quality_and_management_tools&action=edit&section=2" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/APACHE_II" title="APACHE II">APACHE II</a></li> <li><a href="/wiki/SAPS_III" title="SAPS III">SAPS III</a></li> <li><a href="/wiki/Intensive_care_unit" title="Intensive care unit">Intensive care unit</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=ICU_quality_and_management_tools&action=edit&section=3" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFGallesioCerasoPalizas2006" class="citation journal cs1">Gallesio, Antonio O.; Ceraso, Daniel; Palizas, Fernando (July 2006). 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Epub 2020 Jul 13.</li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=ICU_quality_and_management_tools&action=edit&section=4" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="https://web.archive.org/web/20090319071651/http://www.mdcalc.com/apache-ii-score-for-icu-mortality">APACHE II Score online</a></li> <li><a rel="nofollow" class="external text" href="http://www.saps3.org/resources-downloads/user-agreement/downloads/">SAPS II Scoring Sheets and Database</a></li></ul> <!-- NewPP limit report Parsed by mw‐web.eqiad.main‐59856bd7d8‐65chn Cached time: 20241119192208 Cache expiry: 2592000 Reduced expiry: false Complications: [vary‐revision‐sha1, show‐toc] CPU time usage: 0.149 seconds Real time usage: 0.186 seconds Preprocessor visited node count: 356/1000000 Post‐expand include size: 15690/2097152 bytes Template argument size: 297/2097152 bytes Highest expansion depth: 12/100 Expensive parser function count: 2/500 Unstrip recursion depth: 0/20 Unstrip post‐expand size: 12631/5000000 bytes Lua time usage: 0.105/10.000 seconds Lua memory usage: 4313754/52428800 bytes Number of Wikibase entities loaded: 0/400 --> <!-- Transclusion expansion time report (%,ms,calls,template) 100.00% 164.077 1 -total 61.03% 100.128 5 Template:Cite_journal 38.65% 63.410 1 Template:Essay-like 20.86% 34.220 1 Template:Ambox 7.54% 12.364 1 Template:DMCA 5.49% 9.015 1 Template:Dated_maintenance_category 4.05% 6.638 1 Template:FULLROOTPAGENAME 3.12% 5.119 1 Template:Ns_has_subpages --> <!-- Saved in parser cache with key enwiki:pcache:19530493:|#|:idhash:canonical and timestamp 20241119192208 and revision id 1110610649. 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