Contents

• Introduction
• ICCMU Quality Group
  • Minutes
• Projects
  • Exploring data collection processes and data quality in NSW ICUs
    • Publications & Presentations
    • Bibliography
  • Process of care
    • Publications & Presentations
    • Bibliography
  • ICU Safety Culture
    • Publications & Presentations
    • Bibliography
    • Links
  • AMRS
  • ICU Indicators

Please note that any ICCMU documents cannot be housed at any other website without the express permission of the copyright owner. This includes online document sites.

Introduction

One of ICCMU's main aims is to work with clinicians and key organisations to identify, address, and improve quality and safety issues in NSW ICUs. These webpages will highlight some of the current quality and safety (Q&S) issues that have been identified and are being addressed via various projects. There is a section dedicated to infection control, a highly important issue for intensive care practice. Other useful content includes a Resource Library for access to tools and practical information about various Q&S projects and Weblinks to sites containing related or further information of interest.

ICCMU's role in Quality & Safety Research is reflected in two of its three main objectives:

• Promoting excellence in the standard of care in all NSW ICUs by providing a forum for the systematic analysis and assessment of information regarding the quality of care in NSW intensive care units (see ICCMU Quality Group below).
• Facilitating an understanding of Intensive Care service provision including resources, workforce, patterns of demand including access issues, and other factors that may impact on the effective delivery of intensive care service in NSW through the Data Management Committee.

ICCMU works collaboratively with a number of organisations and key groups in NSW and Australia to achieve these goals including:

• NSW Clinical Excellence Commission
• UTS Faculty of Nursing, Midwifery & Health
• ANZICS Centre for Outcome and Resource Evaluation (CORE)
• ANZICS Safety & Quality Committee
• ANZICS Clinical Trials Group
• George Institute for International Health
• Aero-medical Retrieval Service (AMRS)
• Australian College of Critical Care Nurses (ACCCN)

ICCMU Quality Group

The ICCMU Quality Group (ICCMUQG) provides a forum for the systematic analysis, assessment and dissemination of information regarding the quality of care (Objective C) in NSW intensive care units: in particular, incident monitoring, clinical indicators and clinical audits. ICCMUQG uses a multi-modal approach to reviewing quality in NSW ICUs. Work continues on collating, reviewing and reporting relevant information from databases, such as the ANZICS Adult Patient Database (APD), Health Information Exchange (HIE), and the Critical Care Resource system (CCRS). ICCMUQG also holds meetings with relevant members of the Clinical Excellence Commission, ANZICS Safety & Quality Committee, ANZICS Centre for Outcome and Resource Evaluation (CORE), and NSW Health, amongst others.

Minutes of Quality Group meetings

Projects Overview

Quality & Safety projects undertaken by ICCMU include:

Exploring data collection processes and data quality in NSW ICUs

The results of the first survey were presented in a poster at the 5th Australasian Conference on Safety and Quality in Health Care, Melbourne (2007) and as an oral presentation at the 1st International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care, Queenstown, NZ (2007). A paper detailing the results of the first survey was published in Critical Care & Resuscitation (December 2008- see reference in list below).

A follow-up survey to ICU directors was completed in 2008. The aims of this study were to:

1. Further evaluate the quality of data collected for and submitted to the ANZICS APD; and
2. Investigate the perceptions of NSW ICU directors in relation to issues pertaining to ICU data quality, reporting and usage, including the value that is placed on these issues at the local ICU level.

Results of this study were published in Anaesthesia & Intensive Care (April 2012 – see reference list below)

• Publications or presentations arising include

• Hewson-Conroy KM, Tierney LT, Burrell AR. Assessment and perceptions of intensive care data quality, reporting and use: a survey of ICU directors. Anaesthesia & Intensive Care, 2012; 40(4):675-982.
• Hewson-Conroy KM, Burrell AR. Preliminary insights into data collection processes in New South Wales intensive care units. Crit Care Resusc 2008; 10: 301-305.
• Hewson-Conroy KM, Burrell AR. (2007) Preliminary insights into data collection processes Australasian Quality & Safety Conference [poster]
• Hewson-Conroy KM, Burrell AR. (2007) Preliminary insights into data collection processes in New South Wales intensive care units. Ist International Conference on Safety, Quality, Audit & Outcomes in Intensive Care, Queenstown, New Zealand, 8-10 August 2007 [Oral presentation]

• Other suggested reading
  • Needham DM et al 2009 Improving data quality control in quality improvement projects. In International J. for Quality in health Care 21:145-149. Pub Med access.
  • Arts DG et al 2002: Defining and improving data quality in medical registries: A literature review, case study and generic framework. J. of AMIA 9: 600-611. Pub Med access.
  • Martin J et al 2009: Designing and implementing an Australian and New Zealand intensive care data audit study. Int. J of Health Care Quality Assurance 22:572-581. Pub Med access.

Process of care in NSW ICUs.

This ongoing project involves the development, implementation and evaluation of a "process of care" checklist, designed to assist ICU clinicians with the delivery of daily care to their patients. A paper-based checklist pilot has been completed and the results were presented as an oral presentation at the 1st Critical Care Conference in the Vineyards, Hunter Valley (2006), a poster presentation at the 4th Australasian Conference on Safety and Quality in Health Care, Melbourne (2006) and published in Anaesthesia and Intensive Care (June 2006- see list below).

Checklist validation work has been completed via a medical record audit, revealing a strong positive correlation between checklist responses and cares documented in the medical record. Content development work for an electronic checklist to be delivered by a Palm PDA was completed via a comprehensive literature review and a modified - Delphi technique with senior ICU clinicians, to develop clear, concise checklist statements that were based on the latest clinical evidence and/or expert opinion. This work was presented at the 3rd International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care Conference, Queenstown (2009).

In determining the need for tools to assist clinicians in delivering essential processes of care in Australian and New Zealand ICUs, a point prevalence study was conducted. Results demonstrated variability in the delivery of identified cares both within and between ICUs. The results of this study have been presented, and were published in the September issue of Anaesthesia and Intensive Care (see reference list below).

The next phase of the research was a prospective before-after study evaluating the effect of implementing an electronic checklist in a tertiary ICU. A methods paper was presented at the 4th International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care conference, Creswick (2010). The results of this study were presented at the 35th Australian and New Zealand annual Scientific Meeting on intensive Care conference, Melbourne (2010).

• Publications or presentations arising include

• Hewson KM, Burrell AR. A pilot study to test the use of a checklist in a tertiary intensive care unit as a method of ensuring quality processes of care. Anaesth Intensive Care 2006; 34:322-328.
• Hewson KM, Burrell AR. (2006) A pilot study to test the use of a checklist in a tertiary intensive care unit as a method of ensuring quality processes of care.Australasian Quality & Safety Conference
• Hewson KM, Burrell AR. A pilot study to test the use of a checklist in a tertiary intensive care unit as a method of ensuring quality processes of care.Critical Care in the Vineyards
• Hewson KM, Elliott D & Burrell AR Improving process of care in NSW ICUs through collaboration & innovation. UTS Health Research Showcase, 19-20 November 2008 [oral presentation]
• Hewson KM & Burrell AR (2008)CTG Point prevalence study: process of care in ICU, 2nd International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care, Queenstown [oral presentation]
• Hewson-Conroy K (2009) Development and validation of a 'process of care' checklist for intensive care units.3rd International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care, Queenstown [oral presentation].
• Burrell A, Hewson-Conroy K, Elliott D, Seppelt I, Webb S (2009) Compliance with processes of care in the intensive care unit. 34th Australian and New Zealand Annual Scientific Meeting on Intensive Care Conference; Perth. [ oral presentation: unpublished].
• Hewson KM, Elliott D, Burrell AR (2010) Electronic checklist as a strategy for improving processes of care. 4th International Conference on Safety, Quality, Audit and Outcomes Research in Intensive Care, Creswick. [oral presentation]
• Hewson-Conroy KM, Elliott D, Burrell AR. Quality and Safety in Intensive Care - A means to an end is critical. Australian Critical Care 2010; 23:109-129. Pub Med Link.
• Hewson K, Elliott D, Burrell A (2010) Electronic checklist improves care delivery in tertiary intensive care unit. 35th Australian and New Zealand Annual Scientific Meeting on Intensive Care Conference; Melbourne. [oral presentation].
• Hewson-Conroy KM, Burrell AR, Elliott D, Webb SAR, Seppelt IM, Taylor CB, Glass P. Compliance with processes of care in Intensive Care Units in Australia and New Zealand – a point prevalence study. Anaesthesia & Intensive Care, 2011; 39: 926-935.
• Conroy KM, Elliott D, Burrell AR. Validating a process-of-care checklist for intensive care units. Anaesthesia & Intensive Care (accepted 2 March, 2013).

• Other suggested reading

ICU Safety Culture

A pilot of the implementation of the Safety Attitudes Questionnaire (SAQ) to assess the perceived culture of safety in a tertiary ICU was completed and results were presented to the ICU and at the 1st International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care, Queenstown, NZ (2007). This has led to a joint ACCCN and ANZICS Safety & Quality Committee study which was conducted in 10 Australian ICUs. Results were published in the American Journal of Critical Care (February 2013, see reference list below).

• Publications or presentations arising
  • Chaboyer W, Chamberlain D, Hewson-Conroy K, Grealy B, Elderkin T, Brittin M, McCutcheon C, Longbottom P, Thalib L. Safety culture in Australian intensive care units: Establishing a baseline for quality improvement. American Journal of Critical Care, 2013; 22(2):93-102.
  • Hewson KM (2007) Assessing the safety culture in a tertiary ICU 1st International Conference on Safety, Quality, Audit & Outcomes Research in Intensive Care, Queenstown [oral presentation]
  • Hewson KM (2008) Assessing the safety culture in a tertiary ICU. Australasian Quality & Safety Conference

• Suggested reading

• Useful links:

• The University of Texas Center of Excellence for Patient Safety Research and Practice Owner of copyright to the Safety Attitudes Questionnaire (SAQ) and Safety Climate Survey (SCS). Contains survey tools, tracking forms, user guides, instructions and technical report.
• WHO Patient Safety Research 2012: A Guide for Developing Training Programs. This guide outlines the core skill and knowledge-based competencies that professionals at various levels of expertise may wish to acquire to conduct effective patient safety research and improvement efforts.

Aeromedical Retrieval Service

AMRS data is presented in reports to the CCT.  ICCMU also responds to various information requests that arise with regards to interhospital transfers e.g. for AHS service planning and ministerials.

Access to AMRS reports (CCT members only)

ICU indicators

The ICCMUQG advised the ANZICS Safety & Quality Committee on the indicators to be put to the ACHS for ICU indicators in 2007. ICU data items are being developed by ICCMU in conjunction with the Data Management Committee for inclusion in a minimum dataset for reporting by ICU Data Managers. ICCMU continues to work in conjunction with ANZICS on the development of ICU quality indicators for Australia and New Zealand.

ICCMU has had significant input into the 'NSW Intensive Care Services Quality Indicator Reporting Background Paper' that has been developed in response to recommendations made by the Independent Pricing and Regulatory Tribunal (IPART) after a review of health services in regard to efficiency, cost and clinical quality. The final IPART report was issued in July 2010 and can be accessed at www.ipart.nsw.gov.au. Forty recommendations in total were made regarding areas for improvement. Recommendation 38 was related specifically to 'measuring care and/or outcomes in ICUs'.

ICCMU is currently looking into ICU occupancy - its definition, measurement, benchmarking and use as a quality indicator. A literature review is under way to help inform statewide planning. Information resulting from this work will be made available in due course. NSW ICU occupancy data is currently reported real-time via the Critical care Resource System (CCRS)

• Australasian Clinical Indicator Report: 2001-2007
• NSW Intensive Care Services Quality Indicator Reporting Backgroound Paper

If there is something you think is relevant and appropriate please contact ICCMU.

• NSWHealth Quality and Safety Internet