TY - JOUR
T1 - Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury
AU - Delphi Panel
AU - Huijben, Jilske A.
AU - Wiegers, Eveline J. A.
AU - de Keizer, Nicolette F.
AU - Maas, Andrew I. R.
AU - Menon, David
AU - Ercole, Ari
AU - Citerio, Giuseppe
AU - Lecky, Fiona
AU - Wilson, Lindsay
AU - Cnossen, Maryse
AU - Polinder, Suzanne
AU - Steyerberg, Ewout W.
AU - van der Jagt, Mathieu
AU - Lingsma, Hester F.
AU - Aries, Marcel
AU - Badenes, Rafael
AU - Beishuizen, Albertus
AU - Bilotta, Federico
AU - Chieregato, Arturo
AU - Cingolani, Emiliano
AU - Cnossen, Maryse
AU - Coburn, Mark
AU - Coles, Jonathan P.
AU - Delargy, Mark
AU - Depreitere, Bart
AU - Flaatten, Hans
AU - Golyk, Volodymyr
AU - Grauwmeijer, Erik
AU - Haitsma, Iain
AU - Helbok, Raimund
AU - Hoedemaekers, Cornelia
AU - Jacobs, Bram
AU - Jellema, Korne
AU - Koskinen, Lars-Owe D.
AU - Maegele, Marc
AU - Martin Delgado, Maria Cruz
AU - Moller, Kirsten
AU - Moreno, Rui
AU - Nelson, David
AU - Oldenbeuving, Annemarie W.
AU - Payen, Jean-Francois
AU - Pejakovic, Jasmina
AU - Ribbbers, Gerard M.
AU - Rossaint, Rolf
AU - Schoonman, Guus Geurt
AU - Steiner, Luzius A.
AU - Stocchetti, Nino
AU - Silvio, Fabio
AU - van den Bergh, Walter M.
AU - Vos, Pieter E.
PY - 2019/3/22
Y1 - 2019/3/22
N2 - BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.
AB - BackgroundWe aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators.MethodsA preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool.ResultsThe expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N=24, 48%) and neurosurgeons (N=7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N=49, 98%) and indicated routine measurement in registries (N=41, 82%), benchmarking (N=42, 84%), and quality improvement programs (N=41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N=48, 98%).ConclusionsThis Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.
KW - Quality indicators
KW - Benchmarking
KW - Traumatic brain injury
KW - Intensive care unit
KW - Trauma registry
KW - Quality of care
KW - NEUROTRAUMA EFFECTIVENESS RESEARCH
KW - OF-CARE
KW - HOSPITAL-CARE
KW - MANAGEMENT
KW - ADHERENCE
KW - VALIDITY
KW - BENCHMARKING
KW - GUIDELINES
KW - CHILDREN
KW - OUTCOMES
U2 - 10.1186/s13054-019-2377-x
DO - 10.1186/s13054-019-2377-x
M3 - Article
SN - 1466-609X
VL - 23
JO - Critical Care
JF - Critical Care
M1 - 95
ER -