Critical Care DatabaseCritical Care Database(in B.C.)(in B.C.)

Measurement for Operations, Measurement for Operations, Improvement, and ResearchImprovement, and Research

History and Current UsersDate Site

1997/98 Joint development by SPH, VGH, Victoria ICU physicians

1999 PHC: St. Paul’s Hospital

2000 VCHA: Vancouver General Hospital

2002 Richmond Hospital

2005 Lion’s Gate Hospital

2006 Mount St. Joseph

2006 FRASER HEALTH: Royal Columbian, Surrey, Burnaby, Peace Arch

2008 Powell River (1-year); Royal Columbian Hospital High Acuity Unit

February 2009 Abbotsford, Langley, Chilliwack, Ridge Meadows

August 2009 NORTHERN HEALTH: Prince George

Structure• Oracle platform• Web-based (no copy of database on local computers)

• Use of existing standard nomenclature/labels:

– Diagnoses: ICNARC and APACHE

– Services: CIHI

• Explicit definitions of all fields:

– eg. procedures, elements of severity scores, safety

outcomes

Privacy • Database housed on PHC server within CHEOS• Site-specific view – can access and view patients’ files specific

to own ICU only• 2 levels of sign-on authentication (unique password for each

user)• Forced requirement to change password on a regular basis• Failed attempts & “idle” time = lock out• Encrypted data transfer• Ability to audit database access (by date & user

authentication)• Privacy Impact Assessment completed

Database ContentDemographics,

Visit information (ICU & Hospital)

Admission InformationDischarge Information

Outcomes

DiagnosesInterventions

Arterial & Central Lines

Severity of Illness:Apache IIApache IV

SOFA

Level of CareOverflow

Avoidable Days

MinimumDataset

Patient Safety Measures:•Clostridium Difficile

•Hypoglycemic Events•Major Bleeds (on anticoagulants)

•Central Venous catheter associated bloodstream

infections•Unplanned extubations

•Suspected Ventilator-associated pneumonia

Vasoactive Drugs

Blood Products

RASS (sedation score)Delirium score

TRISS (VGH only)

Optional Dataset

Many Uses for the ICU Database• Describe clinical care—processes and outcomes• Utilization management—occupancy, volume of

activity• Patient Quality & Safety Initiatives• Internal/external performance indicators• Management of staff• Measure effects of changes in care• Planning• Collaboration with others• Research (approval and ethics)

7

VGH ICU Admissions: 11 – Year Summary

Occupancy and Patient-Days--SPH

10

VGH ICU Occupancy Based on ICU Database vs. census at midnight vs. census at noon

0

5

10

15

20

25

30

35

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

ICU

Bed

s U

tili

zed

January 2010

Census at 12 noon Census at 12 midnight

Levels of Care--SPH

Aging Population

Distribution of ICU Diagnoses

Admission Times--VGH

Discharge Times--VGH

? Delayed ICU care?

5.9 6.9 8.4

20

24

32

0

5

10

15

20

25

30

35

40

45

24 hours 2-7 days > 8 days

Hospital Mortality

LOS

Effect of Critical Care Outreach Team

Some Recent Research ProjectsSome Recent Research Projects• Variation in length of ICU stay after cardiac arrest: where you are is as

important as who you are. Critical Care Medicine. 2007; 35: 836-841.

• Pneumothorax After Insertion of Central Venous Catheters in the Intensive Care Unit: Association with Month of Year and Week of Month. Quality and Safety in Health Care, 2007 16: 252-255

• Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent. Chest. 2008; 134: 1217-1222.

• Reliability of ICU Admitting and Comorbid Diagnoses, Race, Elements of APACHE II Score, and Predicted Probability of Mortality in an Electronic ICU Database. Journal of Critical Care. 2009; 24: 401-407.

• Introduction of a comprehensive management protocol for severe sepsis is associated with sustained improvements in timeliness of care and survival. Quality and Safety in Health Care. 2010; 19: 1-7.

• Nursing Work Schedules and the Risk of Hypoglycemia in Critically Ill Patients Receiving Intravenous Insulin. Quality and Safety in Health Care 2010; 19: 1-4.

Involvement with OthersInvolvement with Others

• Canadian Critical Care Vital Signs Monitor (CCVSM)

– Web-based national ICU reporting system since 2008

– 24 sites in 5 provinces

– 20 indicators

– Data are stratified and reported according to peer group: academic/teaching, medical, surgical, trauma, cardiovascular

• Canadian Critical Care Trials Group—Knowledge Translation Network (coming soon)

The Future• Measurement to improve all dimensions of Measurement to improve all dimensions of

qualityquality• Integration

– Within institutions– Between institutions– Within regions– Between regions– Provincial—a critical care system

• ‘‘Backbone’ for a community of practice among Backbone’ for a community of practice among ICU personnel in B.C. (and across Canada)ICU personnel in B.C. (and across Canada)

Screen Shots

Severity of Illness Measures

Optional Data Screens