The present use of quality indicators in the intensive care unit

Quality indicators (QIs) are increasingly used in medicine in order to compare and eventually to improve quality of delivered health care. During the last decade, QIs also have been used within intensive care medicine. This paper shortly describes this development and gives an overview of QIs in the intensive care unit (ICU) reported to be in use at national level. Using a search on PubMed and through World Wide Web, QIs documented to be in use at a national level were retrieved. The various sets of QI were compared, and the method to select QIs was found. The search retrieved national indicators from eight countries (United Kingdom, the Netherlands, Spain, Sweden, Germany, Scotland, Austria and India). A total of 63 QIs were in use, and no single indicator was common for all countries. The most frequently used indicator was the standardised mortality rate (in six of eight countries). Measurements of patient/family satisfaction, the presence of an ICU specialist 24/7 and the occurrence of ventilator-associated pneumonia were all used by five countries. All primarily used a physician-driven process to select national QIs. This survey reveals that the concept of QIs is perceived differently throughout countries, also within developed countries in Western Europe. At present, it will be difficult to use national QIs to compare the quality of intensive care between countries.