TY - JOUR
T1 - Quality improvement of Dutch ICUs from 2009 to 2021
T2 - A registry based observational study
AU - Roos-Blom, Marie-José
AU - Bakhshi-Raiez, Ferishta
AU - Brinkman, Sylvia
AU - Arbous, M. Sesmu
AU - van den Berg, Roy
AU - Bosman, Rob J.
AU - van Bussel, Bas C. T.
AU - Erkamp, Michiel L.
AU - de Graaff, Mart J.
AU - Hoogendoorn, Marga E.
AU - de Lange, Dylan W.
AU - Moolenaar, David
AU - Spijkstra, Jan Jaap
AU - de Waal, Ruud A. L.
AU - Dongelmans, Dave A.
AU - de Keizer, Nicolette F.
N1 - Publisher Copyright: © 2023 The Authors
PY - 2024/2
Y1 - 2024/2
N2 - Purpose: To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry. Materials and methods: We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC). Results: 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021. Conclusions: Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.
AB - Purpose: To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry. Materials and methods: We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC). Results: 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021. Conclusions: Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.
KW - Cluster analysis
KW - Intensive care units
KW - Quality improvement
KW - Quality indicator
KW - Trends
UR - http://www.scopus.com/inward/record.url?scp=85176426054&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcrc.2023.154461
DO - https://doi.org/10.1016/j.jcrc.2023.154461
M3 - Article
C2 - 37951771
SN - 0883-9441
VL - 79
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154461
ER -