Journal Articles

Systematic review and directors survey of quality indicators for the cardiovascular intensive care unit

March 15, 2018

Michael Goldfarb, Lior Bibas, L. Kristin Newby, Timothy D. Henry, Jason Katze, Sean van Diepen, Bojan Cercek (2018). Systematic review and directors survey of quality indicators for the cardiovascular intensive care unit. International Journal of Cardiology.

Author Affiliations

Division of Pulmonary and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA, United States
Division of Cardiology, McGill University, Montreal, Quebec, Canada
Division of Cardiology, Duke University, Durham, NC, United States
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada

Abstract

Background
Quality indicators (QIs) are increasingly used in cardiovascular care as measures of performance but there is currently no consensus on indicators for the cardiovascular intensive care unit (CICU).

Methods
We searched Medline, CINAHL, EMBASE, and COCHRANE databases from inception until October 2016 and websites for organizations involved in quality measurement for QIs relevant to cardiovascular disease in an intensive or critical care setting. We surveyed 14 expert cardiac intensivist–administrators (7 European; 7 North American) on the importance and relevance of each indicator as a measure of CICU care quality using a scale of 1 (=lowest) to 10 (=highest). Indicators with a mean score ≥8/10 for both importance and relevance were included in the final set.

Results
Overall, 108 QIs (70 process, 18 structural, 18 outcome, 1 patient engagement, and 1 covering multiple domains) were identified in 30 articles representing 23 agencies, organizations, and societies. Disease-specific QIs included myocardial infarction (n = 37), heart failure (n = 31), atrial fibrillation (n = 11), and cardiac rehabilitation (n = 1); general QIs represented about one-quarter (n = 28) of all measures. Fifteen QIs were selected for the final QI set: 7 process, 2 structural, and 6 outcome measures, including 6 general and 9 disease-specific measures. Outcome measures chosen to evaluate general CICU performance included overall CICU mortality, length of stay, and readmission rate.

Conclusions
Numerous QIs relevant to the CICU have been recommended by a variety of organizations. The indicators chosen by the cardiac intensivist–administrators could serve as a basis for future efforts to develop a standardized set of quality measures for the CICU.

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