Abstract
We describe an audit system used in our Medical/Surgical Intensive Care Unit (ICU) during 1989–90. The system emphasizes the integration of data acquisition (database function) with the analysis and use of data (decision function). Resource input (human and technological) included patient demographics, diagnoses, complications, procedures, severity of illness (Apache II), therapeutic interventions (TISS), and nursing workload (GRASP and TISS). The output was assessed by survival, length of stay and ability to return home. The annual operating cost for 277 admissions (249 patients) to this ICU was $7,333. The implementation costs were $58,261 including program development and computer purchases. Non-survivors of ICU and hospital had higher Apache II scores on admission (P < 0.0001) and longer ICU length of stay (P < 0.05) than survivors. The nursing workload (both TISS and GRASP®) on the day of admission and the last day in ICU were greater in non-survivors (P < 0.0001) than survivors. Limitations of this audit system included the delay (6–9 mos) from ICU admission until data entry, the large number of diagnostic groups in the ICD.9.CM classification, and lack of a documented cause/effect relationship between interventions and complications. This audit system was more useful for utilization management than for quality assurance purposes.
Résumé
Nous décrivons un système de vérification utilisé en 1989–90 dans nos soins intensifs chirurgicaux et médicaux. Le système met l’accent sur l’intégration de l’acquisition des données (fonction database) avec l’analyse et l’utilisation de ces données (fonction décision). Les entrées (humaines et technologiques) englobaient les données démographiques des patients, les diagnostiques, les complications, les procédures, la sévérité de la maladie (Apache II), les interventions thérapeutiques (TISS), et la charge de travail infirmier (GRASP et TISS). Le rendement (output)était évalué à l’aide de la survie, de la durée du séjour et de l’habilité du patient à retourner à la maison. Le coût d’opération annuel de cet unité de soins intensifs était de $7 333 pour 277 admissions (249 patients). Les coûts d’implantation étaient de $58 261, incluant le développement du programme et l’achat des ordinateurs. Les patients qui décédaient aux soins intensifs ou à l’hôpital avaient un pointage Apache II plus élevé à l’admission (P < 0,0001) et un séjour aux soins intensifs plus long (P < 0,05) que les patients qui survivaient. La charge de travail infirmier (TISS et GRASP) le jour de l’admission et la dernière journée aux soins intensifs était plus élevée chez les patients qui décédaient que chez les patients qui survivaient (P < 0,0001). Les limites de ce système de vérification comprenaient le délai entre l’admission aux soins intensifs et l’entrée des données (six à neuf mois), le nombre élevé de groupes diagnostiques dans la classification ICD.9.CM, et le manque d’une relation cause à effet documentée entre les interventions et les complications. Ce système de vérification a été plus utile pour gérer l’utilisation des soins intensifs que pour assurer une qualité de soins.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Bion J. Audit in intensive care.In: Vincent JL (Ed.). Update in Intensive Care and Emergency Medicine. Springer-Verlag 1990: 851–6.
Gumpert R, Lyons C. Setting up a district audit programme. Br Med J 1990; 301: 1625.
Linton AL, Peachey DK. Utilization management: a medical responsibility. Can Med Ass J 1989; 141: 283–6.
Shabot MM, Leyerle BJ, LoBue M. Automatic extraction of intensity-intervention scores from a computerized surgical intensive care unit flowsheet. Am J Surg 1987; 154: 72–8.
Muakkassa FF, Fakhry SM, Rutledge R, Hsu H, Meyer AA. Cost-effective use of microcomputers for quality assurance and resource utilization in the surgical intensive care unit. Crit Care Med 1990; 18: 1243–7.
Ross DG, Ramayya P, Kulkarni V. ABICUS: Aberdeen Intensive Care Unit system. Int J Clin Mon Comp 1990; 7: 69–81.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818–29.
Keene AE, Cullen DJ. Therapeutic intervention scoring system: update 1983. Crit Care Med 1983; 11: 1–3.
Meyers D. GRASP, a patient information and workload management system. Morgantown, N.C., M.C.S.I., 1978.
International Classification of Diseases, 9th edition, clinical modification. Washington: US Government Printing Office, 1980; US Dept of Health and Human Services (publication no. 80–1260) (PHS) vol. 1,2.
Wagner DP, Knaus WA, Draper EA. Statistical validation of a severity of illness measure. Am J Public Health 1983; 73: 878–84.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. Prognosis in organ system failure. Ann Surg 1985; 6: 685–93.
Cullen DJ, Civetta JM, Briggs BA, Ferrara LC. Therapeutic intervention scoring system: a method for quantitative comparison of patient care. Crit Care Med 1974; 2: 57–60.
Fleming CC, Von HalleB. Handbook of Relational Database Design. Wollman K, Dupre L (Eds.). Addison-Wesley Publishing Co., Inc. Reading, Mass., USA 1989.
O’Brien-Pallas L, Lean P, Deber R, Till J. A comparison of workload estimates using three methods of patient classification. Canadian Journal of Nursing Administration 1989; 2: 16–23.
Stein M. Report of the Ontario Data Quality Reabstracting Study by Ontario Hospital Association, Ontario Ministry of Health and Hospital Medical Records Institute. Toronto, Ontario, April 1991.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centres. Ann Intern Med 1986; 104: 410–8.
Russell LB. The role of technology assessment in cost control.In: McNeil BJ, Carvalho EG (Eds.). Critical Issues in Medical Technology. Boston: Auburn House 1982; 129–38.
Spivak D. The high cost of acute health care: a review of escalating costs and limitations of such exposure in intensive care units. Am Rev Respir Dis 1987; 136: 1007–11.
Linton AL, Naylor CD. Organized medicine and the assessment of technology. N Engl J Med 1990; 323: 1463–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Byrick, R.J., Caskennette, G.M. Audit of critical care: aims, uses, costs and limitations of a Canadian system. Can J Anaesth 39, 260–269 (1992). https://doi.org/10.1007/BF03008787
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03008787