Intensive Care Medicine

, Volume 38, Issue 4, pp 598-605

First online:

Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM)

  • A. RhodesAffiliated withDepartment of Intensive Care Medicine, St George’s Healthcare NHS Trust and St George’s University of London Email author 
  • , R. P. MorenoAffiliated withUnidade de Cuidados Intensivos Polivalente, Hospital de St. António Dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E
  • , E. AzoulayAffiliated withService de Réanimation Médicale, Hôpital Saint-Louis, Université Paris 7
  • , M. CapuzzoAffiliated withSection of Anaesthesiology and Intensive Care, Department of Surgical, Anaesthetic and Radiological Sciences, University Hospital of Ferrara
  • , J. D. ChicheAffiliated withRéanimation Médicale-Hôpital Cochin
  • , J. EddlestonAffiliated withManchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust
  • , R. EndacottAffiliated withFaculty of Health, University of Plymouth
  • , P. FerdinandeAffiliated withSurgical and Transplantation ICU, University Hospital Gasthuisberg
  • , H. FlaattenAffiliated withHaukeland University Hospital
    • , B. GuidetAffiliated withService de réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de ParisUPMC Univ Paris 06, INSERM, Unité de Recherche en Épidémiologie Systèmes d’Information et Modélisation (U707)
    • , R. KuhlenAffiliated withHELIOS Kliniken GmbH, Geschäftsführer Medizin
    • , C. León-GilAffiliated withServicio de Cuidados Críticos y Urgencias, Hospital Universitario de Valme
    • , M. C. Martin DelgadoAffiliated withHospital de Torrejón
    • , P. G. MetnitzAffiliated withDepartment of Anesthesia and General Intensive Care, AKH Wien Medical University of Vienna
    • , M. SoaresAffiliated withIDOR–D’Or Institute for Research and Education
    • , C. L. SprungAffiliated withGeneral Intensive Care Unit, Hadassah Hebrew University Medical Center
    • , J. F. TimsitAffiliated withResponsable Médical Clinique Réanimation Médicale (PMAC), Teaching Hospital Albert Michallon, University Grenoble 1
    • , A. ValentinAffiliated withGeneral and Medical ICU, Rudolfstiftung Hospital



To define a set of indicators that could be used to improve quality in intensive care medicine.


An European Society of Intensive Care Medicine Task Force on Quality and Safety identified all commonly used key quality indicators. This international Task Force consisted of 18 experts, all with a self-proclaimed interest in the area. Through a modified Delphi process seeking greater than 90% consensual agreement from this nominal group, the indicators were then refined through a series of iterative processes.


A total of 111 indicators of quality were initially found, and these were consolidated into 102 separate items. After five discrete rounds of debate, these indicators were reduced to a subset of nine that all had greater than 90% agreement from the nominal group. These indicators can be used to describe the structures (3), processes (2) and outcomes (4) of intensive care. Across this international group, it was much more difficult to obtain consensual agreement on the indicators describing processes of care than on the structures and outcomes.


This document contains nine indicators, all of which have a high level of consensual agreement from an international Task Force, which could be used to improve quality in routine intensive care practice.


Intensive care medicine Quality indicators ESICM Task Force