Developing severity adjusted quality measures for intensive care units

PURPOSE: Intensive care unit performance evaluation is usually affected by variations in the severity of inpatients' health status. This paper aims, therefore, to standardize two performance measures: intensive care unit survival and length of stay using the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of illness score. DESIGN/METHODOLOGY/APPROACH: A records study in three Ain Shams University Hospital intensive care units, from January 1-December 31, 2003 was carried out to examine illness severity effect using APACHE II, length of stay and survival. Retrospective data were used to model length of stay in days and the survival using the APACHE II score as a predictor. This was followed by a prospective study to monitor the standardized measures in two intensive care units for one year. FINDINGS: APACHE II scores predicted length of stay of those who were discharged and control charts for severity-adjusted length of stay were drawn up. The APACHE II score predicted survival for those with APACHE II score >16. The model is significant with a specificity of 89.9 percent while sensitivity was 25 percent. Control charts for severity-adjusted mortality were drawn up to monitor mortality. RESEARCH LIMITATIONS/IMPLICATIONS: Only 60 percent of the files examined in the retrospective part of the study had enough data to calculate APACHE II scores. PRACTICAL IMPLICATIONS: Standardized APACHE II severity of illness score can monitor intensive care unit length of stay and mortality. ORIGINALITY/VALUE: The paper underlines the need to implement a standardized measurement system to evaluate intensive care patient outcomes.