الفهرس 
Health care quality conceptsOnly 14 pages are availabe for public view
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Abstract
Summary
QUALITY INDICATORS IN INTENSIVE CARE UNITS 921
QUALITY INDICATORS IN INTENSIVE CARE UNITS
SUMMARY
Quality indicators are standards which if upheld, will likely improve the quality of patient care by means of improved safety, better patient outcomes, and greater efficiency. A quality indicator is a screening tool to identify potential suboptimal clinical care. Quality indicators provide a measure of quality of structure, process, and outcome of care, and can serve as instruments to improve health care. Structure indicators are related to the resources and means to be able to give treatment and care. Process refers to the activities related to treatment and care. Outcome is defined as changes in the state of health of a patient that can be attributed to an intervention or to the absence of an intervention.
Recommendations for the design of intensive care units should be expanding on regulatory guidelines and providing the best possible healing environment and an efficient and cost-effective workplace. Optimal design requires knowledge of best practices, design standards and building codes.
Patients treated in Intensive Care Unit (ICU) may develop various psychiatric disorders which become manifest either in the unit or after discharge, probably due to long ICU stay. The ICU may experience higher infection rates due to the severity of illness of the ICU patients and due to the frequent use of invasive devices. There is also a risk of becoming contaminated with another patient’s microbes or with those in the environment if staff does not maintain basic hand hygiene between patients. Other considerable complications include: mobility disorders, skin disorders and sexual dysfunction .Design of ICU is playing an
Summary
QUALITY INDICATORS IN INTENSIVE CARE UNITS 931
important role in solving these problems and there is no doubt, behavioral and environmental interventions are beneficial, combined with pharmacological solutions.
Processes, this term is used to indicate what we do, or we fail to do for patients and their families during their stay in the ICU. A great number of processes are normally involved in ICU patient care ranging from individual care to general procedures such as admission and discharge and maintenance of equipment. Length of ICU stay, readmission to the ICU within 24 hours after discharge and compliance to selected guidelines, protocols, treatment bundles in the unit are parameters indicating quality of process in the ICU.
Length of ICU stay (ICU LOS) may be calculated as the difference in days between the time of ICU discharge and time of ICU admission. To account for patients being discharged too early, the length of stay of the first ICU admission will be prolonged with the length of stay of subsequent ICU readmissions within the same hospital admission. ICU beds are limited in any hospital. Rationalized use for needy patients therefore is necessary. LOS is, therefore, used to assess quality of care and resource utilization
Readmission to the ICU, within 24 hours of transfer during a single hospital stay is an indicator of post ICU care. Patients readmitted to ICUs have increased hospital mortality and lengths of stay. Compliance to selected guidelines, protocols and treatment bundles in the unit improves patient care, resource utilization, and reduces iatrogenic complications.
The Intensive Care Unit is one of the busiest units in the hospital and uses some of the most sophisticated equipment and advanced medical
Summary
QUALITY INDICATORS IN INTENSIVE CARE UNITS 939
practices. Hospital-acquired infection is common in ICUs. The ICU patient is at increased risk; 20- 28% more acquire an infection by comparison with patients in a non-critical situation. Guidelines issued for the control of infection in hospitals emphasize the importance of maximizing resources in high risk areas such as the ICU and recommend strategies such as the use of isolation rooms and the rigorous cleaning and disinfection of contaminated equipment.
Outcome refers to the results of care. Mortality and morbidity rate, resources utilization, patient satisfaction and infection control are outcome parameters indicating quality in ICUs. The original outcome prediction scores were developed more than 25 years ago to provide an indication of the risk of death of groups of ICU patients, APACHE and SAPS scores are widely used in prediction of outcome (result of care).
Although the APACHE II model is quite old, and other scoring systems have been developed using more recent cohorts, APACHE II is still widely used for research and clinical audit purposes. APACHE II is easier to use than APACHE III and has been in use for a long period, which allows consistency. The APACHE II prognostic index was useful for stratifying patients according to the severity of their health condition. The higher the APACHE II score was, the higher the mortality rate was.
SAPS II score provides reliable prediction of mortality without having to specify a primary diagnosis. The variables in SAPS II score are readily available. No special venous or arterial blood samples are required. Calculation of the score is simple and rapid. The recalibrated SAPS-II score, was obtained as a customization of the popular Simplified Acute Physiology Score (SAPS) II model for predicting mortality In ICU patients aged 80 years or older in 2007.
Summary
QUALITY INDICATORS IN INTENSIVE CARE UNITS 932
Quality and safety are two facets of a system designed to deliver optimum care. Safety is defined as the absence of the potential for, or occurrence of healthcare–associated injury to patients. It is created by avoiding medical errors as well as taking action to prevent errors from causing injury. Patients’ fall rate, medication error, adverse events, needle stick injury rate and re-intubation rate are patient safety parameters indicating quality in ICUs.