defining standards and metrics in the icu · critical care units and value •critical care...

5/9/2015 1 Defining standards and metrics in the ICU James Ramsay MD UCSF Medical Director, CT ICU, Moffitt Hospital “A standard of care is a medical… treatment guideline, and can be general or specific. It specifies appropriate treatment based on scientific evidence and collaboration between medical… professionals involved in the treatment of a given condition.” “Standards” • Practice Advisories • Guidelines • Statements • Bundles • Policies Collections of people (“experts”)getting together and making recommendations based on available evidence and expert opinion Who defines the “standards?” • Government – CDC, other regulatory agencies • Societies – Professional Societies like AHA, SCCM • Institutions – Health Care Systems/consortiums • Unit-based committees

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5/9/2015

Defining standards and metrics in the ICU

James Ramsay MD

UCSF

Medical Director, CT ICU, Moffitt Hospital

“A standard of care is a medical… treatment guideline, and can be general or specific. It specifies appropriate treatment based on scientific evidence and collaboration between medical… professionals involved in the treatment of a given condition.”

“Standards”

• Practice Advisories

• Guidelines

• Statements

• Bundles

• Policies

Collections of people (“experts”)getting together and making recommendations based on available evidence and expert opinion

Who defines the “standards?”

• Government

– CDC, other regulatory agencies

• Societies

– Professional Societies like AHA, SCCM

• Institutions

– Health Care Systems/consortiums

• Unit-based committees

Page 2: Defining standards and metrics in the ICU · Critical Care Units and Value •Critical Care represents 11% of health care spending •Critical Care is associated with high rates of

5/9/2015

28 page module

Page 3: Defining standards and metrics in the ICU · Critical Care Units and Value •Critical Care represents 11% of health care spending •Critical Care is associated with high rates of

5/9/2015

American Heart Association

Standards (or guidelines, or …)

• Are based on “best evidence” to date

• Evolve over time

• Are created in order to guide practice to the best outcomes for the patient

• IOM 2001: “safe, effective, patient-centered, timely, efficient, equitable”

• As they are created by consensus they threaten the autonomy of individual practice

2008

Nash and Quigley 2008

Page 4: Defining standards and metrics in the ICU · Critical Care Units and Value •Critical Care represents 11% of health care spending •Critical Care is associated with high rates of

5/9/2015

Physicians need to:

• Embrace evidence based medicine

– AKA standards, guidelines….

• Strive for improvement = “CQI”

• Endorse transparency in physician performance

– Accurate reporting of outcomes

– Disclosure of errors

Nash and Quigley 2008

Practicing according to standards is becoming mandatory because of

value

Value = Outcome Cost

Institutions, hospitals and clinical units not providing value are destined to be overtaken by those that do

“pay for performance”

5/9/2015

Critical Care Units and Value

• Critical Care represents 11% of health care spending

• Critical Care is associated with high rates of adverse events (iatrogenic and health-care related)

• Critical Care inconsistently delivers evidence-based practices

Developing an ICU value measurement process (Murphy et al 2015)

• Engage a multidisciplinary team

• Identify target areas

• Select an appropriate metric

• Acquire the necessary data

• Analyse and disseminate the findings

Identifying target areas

• Choose areas with greatest “opportunity for improvement”

• Consider potential for staff engagement

• Consider ability to measure

• Consider ability to effect change

• Evaluate structures and processes to identify where to direct improvement efforts

Murphy et al 2015

Page 6: Defining standards and metrics in the ICU · Critical Care Units and Value •Critical Care represents 11% of health care spending •Critical Care is associated with high rates of

5/9/2015

Murphy et al 2015

Page 7: Defining standards and metrics in the ICU · Critical Care Units and Value •Critical Care represents 11% of health care spending •Critical Care is associated with high rates of

5/9/2015

Murphy et al 2015 Murphy et al 2015

Murphy et al 2015

Acquire the data and determine how best to present/disseminate

Displaying data to staff encourages compliance with guidelines

Page 8: Defining standards and metrics in the ICU · Critical Care Units and Value •Critical Care represents 11% of health care spending •Critical Care is associated with high rates of

5/9/2015

Murphy et al 2015

Quality and value metrics: following the “standards”

• Becoming a requirement in the current healthcare environment

• Failure to participate will leave you in the dust

• Release yourself from the hold of autonomy

• Learn and adopt the “standards” relevant to your practice, and stay tuned

• Identify, obtain, and evaluate relevant metrics in order to develop high quality, high value care

[email protected]

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