Clinical performance and resource utilisation of a respiratory intensive care unit. Analysis of five years of clinical activity

Abstract

Background: Improving intensive care unit (ICU) performance is a primary goal in quality of care management; for this purpose, measuring with tools that enable us to make comparisons with proposed standards is necessary. Objective: To describe the clinical performance and resource utilisation of a respiratory ICU (RICU) over a 5-year period. Material and methods: A cross-sectional, retrospective, comparative study was conducted in the RICU of a teaching hospital. Using the revised Rapoport–Teres method, the standardised clinical performance index (SCPI) and the standardised resource utilisation index (SRUI) were calculated annually and for the entire study period. The results were compared with those obtained by the ICUs participating in Project IMPACT (in standard deviations) in a four-quadrant coordinate graph designed for this purpose. SCPI and SRUI values greater than zero indicate better survival and a lower resource utilisation than expected. Values below zero indicate a mortality and resource utilisation higher than expected. Results: In the study period, 1177 patients were admitted to the RICU. Readmissions (n = 34) and patients <18 years old (n = 7) were excluded from the analysis. In 1136 patients, the observed survival rate was 55% and the survival rate predicted by SAPS-3 (simplified acute physiology score) was 74%. The fraction of unscheduled surgery patients, those receiving invasive mechanical ventilation, and those discharged to another hospital were included in the SRUI calculation. The SCPI and the SRUI for the entire study period were −4.0 and 0.94 respectively. Conclusion: Although the resource utilisation index in the RICU is within an acceptable parameter, a clinical performance below the standard is observed. Copying the care model of ICUs with good performance could be beneficial for the RICU to improve its performance.

Keywords

• Clinical performance
• Cost-effectiveness
• Resource utilisation
• Quality management
• Intensive care