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Table 1 What should we benchmark in critical care? Main advantages and disadvantages for different measures and indicators

From: Understanding intensive care unit benchmarking

Domain/measure Advantages Limitations
  Mortality Easy to measure, clinically relevant Has to be risk-adjusted (SMR) with well-calibrated scores, case-mix sensitive, fixed time points are better than ICU/hospital
  Length of stay Easy to measure, clinically relevant, proxy of efficiency Affected by structure, can be artificially lowered by transfers
  ICU readmissions Easy to measure, clinically relevant, indirect marker of clinical process inside and outside ICU. Evaluations of unplanned and early ICU readmissions are preferable as they reflect quality and safety Affected by structure (e.g., step-down units), artificially lowered by transfers and end of life care policies
  ICU acquired complications Indicators of quality of care, there are validated recommended definitions, often modifiable/preventable Affected by case-mix, frequently under-reported, applied definition may vary
 Patient-reported outcomes Post-ICU vital status and quality of life Under-reporting, low-adherence, need for specialized platforms
Process of care
  Adherence to best practices and process of care aimed at preventing complications Reliable surrogate of best practices, extensive EBM literature to support, can be used for audit-feedback purposes Level of evidence varies according to the measures, effect on outcomes is variable, frequently under-reported, tricky to measure at bedside, frequently requires specialized monitoring system
ICU and hospital organization and structure
  Staffing patterns Potentially associated with outcomes, easy to measure Should be adjusted by risk and workload
  ICU structure Can be measured within countries where there are national requirements to provide intensive care; Can allow stratification of levels of care that can be provided by the ICU Wide variation in national standards as well as in the definition of an ICU bed
  1. ICU Intensive care unit, SMR standardized mortality ratio