Process monitoring in intensive care with the use of cumulative expected minus observed mortality and risk-adjusted P charts

Critical Care : the Official Journal of the Critical Care Forum
Jerome G L CockingsRehana K Iqbal

Abstract

A health care system is a complex adaptive system. The effect of a single intervention, incorporated into a complex clinical environment, may be different from that expected. A national database such as the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme in the UK represents a centralised monitoring, surveillance and reporting system for retrospective quality and comparative audit. This can be supplemented with real-time process monitoring at a local level for continuous process improvement, allowing early detection of the impact of both unplanned and deliberately imposed changes in the clinical environment. Demographic and UK Acute Physiology and Chronic Health Evaluation II (APACHE II) data were prospectively collected on all patients admitted to a UK regional hospital between 1 January 2003 and 30 June 2004 in accordance with the ICNARC Case Mix Programme. We present a cumulative expected minus observed (E-O) plot and the risk-adjusted p chart as methods of continuous process monitoring. We describe the construction and interpretation of these charts and show how they can be used to detect planned or unplanned organisational process changes affecting mortality outcomes. Five hundred and eighty-nin...Continue Reading

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Citations

Apr 12, 2006·Critical Care : the Official Journal of the Critical Care Forum·Timothy P Hofer
Sep 4, 2007·Critical Care : the Official Journal of the Critical Care Forum·Marcus J SchultzOgnjen Gajic
May 23, 2012·Critical Care Medicine·Andrew A Kramer
Jul 19, 2013·Critical Care Medicine·Andrew A Kramer
Jun 19, 2010·Journal of Evaluation in Clinical Practice·Tsung-Tai ChenKuo-Piao Chung

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