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  • Measure Summary
  • NQMC:008542
  • Mar 2011

Planning, organization, and management: percentage of critical patients admitted to the ICU after delays greater than 4 hours.

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in July 2015.

Primary Measure Domain

Clinical Quality Measures: Access

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of critical patients admitted to the intensive care unit (ICU) after delays greater than 4 hours.

Rationale

The aim of intensive care medicine is to provide critical patients with the healthcare that they need, ensuring the quality and safety of care. Intensive care medicine is one of the principal components of modern healthcare systems. There is an increasing demand for this resource, which involves high costs.

The quality of care has gradually come to be the central focus of healthcare, and in recent years patient safety has come to represent one of the key aspects of quality. In the case of intensive care medicine, this interest in quality is even more evident, not only because of its social and economic impact, but also because some of the dimensions involved in the quality of care of critical patients take on greater importance: critical patients are more vulnerable, access to critical care is more limited so efforts to distribute resources equitably are more important, scant scientific evidence is available, and the efficiency is limited.

Delays in the admission of critical patients to the intensive care unit (ICU) increase morbidity and mortality as well as increased costs. Delays are usually related to the unavailability of beds in the ICU.

In cases of delayed admission, the critical care physician is still responsible for care of the critical patient (regardless of where the patient is located).

Evidence for Rationale

Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, Bonametti AM. Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011 Jan 18;15(1):R28. PubMed External Web Site Policy

Carter AW, Pilcher D, Bailey M, Cameron P, Duke GJ, Cooper J. Is ED length of stay before ICU admission related to patient mortality?. Emerg Med Australas. 2010 Apr;22(2):145-50. PubMed External Web Site Policy

Chalfin DB, Trzeciak S, Likourezos A, Baumann BM, Dellinger RP, DELAY-ED study group. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit. Crit Care Med. 2007 Jun;35(6):1477-83. PubMed External Web Site Policy

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Restrepo MI, Mortensen EM, Rello J, Brody J, Anzueto A. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest. 2010 Mar;137(3):552-7. PubMed External Web Site Policy

Vidal Tejedor B, Micó Gómez M, Abizanda Campos R, Alvaro Sánchez R, Belenguer Muncharaz A, Mateu Campos L, Andrés EB. [Bias in time delay in ICU admission as a mortality risk factor or "lead time bias"]. Med Intensiva. 2008 Aug-Sep;32(6):272-6. PubMed External Web Site Policy

Primary Health Components

Planning; organization; management; delayed admission

Denominator Description

Total number patients discharged from the intensive care unit (ICU) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of critical patients admitted to the intensive care unit (ICU) after delays greater than 4 hours (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Intensive Care Units

Professionals Involved in Delivery of Health Services

Nurses

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Age greater than or equal to 18 years

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Institutionalization

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Total number patients discharged from the intensive care unit (ICU)

Population: All patients discharged from the critical care department during the period reviewed.

Exclusions
Patients transferred from another center

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Number of critical patients admitted to the intensive care unit (ICU) after delays greater than 4 hours

Delay: Time interval from indication for admission by a critical care physician to actual admission to the ICU.

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Administrative clinical data

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Prescriptive standard

Prescriptive Standard

Standard: 5%

Evidence for Prescriptive Standard

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Original Title

Delayed admission to the ICU.

Measure Collection Name

Quality Indicators in Critically Ill Patients

Measure Set Name

Planning, Organization, and Management

Submitter

Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

Developer

Spanish Society of Intensive and Critical Care and Units Coronary - Clinical Specialty Collaboration

Funding Source(s)

Boehringer Laboratories

Composition of the Group that Developed the Measure

Work Group for Planning, Organization, and Management

  • María Cruz Martín Delgado
  • Luis Ángel Domínguez Quintero
  • Francisca Prieto Valderrey
  • Emilio Moreno Millán
  • Francisco Fernández Dorado
  • Blanca Obón Azuara
  • Isabel Gutiérrez Cia
  • Roser Anglés Coll
  • Miguel Soto Ibáñez
  • Juan Roca Guiseris
  • Paz Merino de Cos
  • Joaquín Álvarez Rodríguez

Scientific Coordination:

  • Maria Cruz Martín Delgado
  • Jesús Blanco Varela
  • Lluís Cabré Pericas
  • Pedro Galdos Anuncibay
  • Federico Gordo Vidal

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2011 Mar

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

2016 Jul

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in July 2015.

Source(s)

Quality indicators in critically ill patients. Madrid (Spain): Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC); 2011. 185 p.

Measure Availability

Source available in English External Web Site Policy and Spanish External Web Site Policy from the Spanish Society of Intensive and Critical Care and Units Coronary (SEMICYUC) Web site.

For more information, contact SEMICYUC at Paseo de la Reina Cristina, 36, 4o D, Madrid, Spain; Phone: +34-91-502-12-13; Fax: +34-91-502-12-14; Web site: www.semicyuc.org External Web Site Policy; E-mail: secretaria@semicyuc.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on April 2, 2014. The information was verified by the measure developer on April 25, 2014.

The information was reaffirmed by the measure developer on July 2, 2015.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

The Quality Indicators in Critically Ill Patients update 2011 can be used by any private or public body only for the purposes of research, clinical management, teaching and education, and will not be used for any other purpose. In all cases, full credit to the Spanish Society of Intensive Care Medicine (SEMICYUC) will be granted. The commercial use of the Quality Indicators in Critically Ill Patients update 2011 is explicitly forbidden.

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