Originating from the surveyors’ practice of placing chiseled horizontal marks in stone structures to form a “bench” for consistent placement of a leveling rod, the term “benchmarking” has evolved to mean the comparison of a business (or healthcare institution) with industry leaders, by evaluating a series of performance metrics. Benchmarking has been divided into the broad categories of process, performance, and strategic benchmarking, and has also been classified as internal (within the same institution) or external benchmarking. In relation to critical care medicine, benchmarking involves the use of quantitative, standardized measurements to allow comparison of performance between intensive care units (ICUs) .
For example, predictive models [e.g., the Acute Physiology and Chronic Health Evaluation (APACHE) score, the Simplified Acute Physiology Score (SAPS), and the Mortality Probability Model MPM)], have been developed and allow comparison of expected and actual mortality of critically ill patients through an evaluation of the severity and context of critical illness. Severity-adjusted mortality rates [or standardized mortality ratios (SMRs)] have been used in ICUs around the world for decades, helping to create a culture of performance evaluation . SMRs have been criticized, however, because of the multiple factors that can affect them, including case-mix, cohort size, data collection methodology, bias in lead time, and the performance of the model. It is clear that case-mix is a key factor and should be considered when using SMRs in the comparative analysis of ICUs.
Although the evaluation of a single ICU over time can produce interesting and insightful results, self-reflection can lead to excessive optimism or criticism. Benchmarking against other ICUs can provide ICU staff and hospital managers with a broader view and clearer perspectives of targets for improvement .
Areas of ICU performance suitable for benchmarking include mortality, adherence to processes of care, patient safety, economic outcomes, and patient or family satisfaction (Table 1). The aim of this report is to highlight the strengths and weaknesses of benchmarking and describe how it can be optimally applied in ICUs.