TY - JOUR

T1 - Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

AU - Huijben, Jilske A.

AU - Wiegers, Eveline J.A.

AU - De Keizer, Nicolette F.

AU - Maas, Andrew I.R.

AU - Menon, David

AU - Ercole, Ari

AU - Citerio, Giuseppe

AU - Lecky, Fiona

AU - Wilson, Lindsay

AU - Cnossen, Maryse C.

AU - Polinder, Suzanne

AU - Steyerberg, Ewout W.

AU - Van Der Jagt, Mathieu

AU - Lingsma, Hester F.

AU - Aries, Marcel

AU - Badenes, Rafael

AU - Beishuizen, Albertus

AU - Bilotta, Federico

AU - Chieregato, Arturo

AU - Cingolani, Emiliano

AU - Coburn, Mark

AU - Coles, Jonathan P.

AU - Delargy, Mark

AU - Depreitere, Bart

AU - Flaatten, Hans

AU - Golyk, Volodymyr

AU - Grauwmeijer, Erik

AU - Haitsma, Iain

AU - Helbok, Raimund

AU - Hoedemaekers, Cornelia

AU - Jacobs, Bram

AU - Jellema, Korné

AU - Koskinen, Lars Owe D.

AU - Maegele, Marc

AU - Delgado, Maria Cruz Martin

AU - Møller, Kirsten

AU - Moreno, Rui

AU - Nelson, David

AU - Oldenbeuving, Annemarie W.

AU - Payen, Jean Francois

AU - Pejakovic, Jasmina

AU - Ribbbers, Gerard M.

AU - Rossaint, Rolf

AU - Schoonman, Guus Geurt

AU - Steiner, Luzius A.

AU - Stocchetti, Nino

AU - Taccone, Fabio Silvio

AU - Takala, Riikka

AU - Tenovuo, Olli

AU - Valeinis, Eglis

AU - the Delphi panel

PY - 2019/3

Y1 - 2019/3

N2 - Background: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results: The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

AB - Background: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results: The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.

KW - Benchmarking

KW - Intensive care unit

KW - Quality indicators

KW - Quality of care

KW - Trauma registry

KW - Traumatic brain injury

U2 - 10.1186/s13054-019-2377-x

DO - 10.1186/s13054-019-2377-x

M3 - Journal article

C2 - 30902117

AN - SCOPUS:85063356926

VL - 23

JO - Critical Care

JF - Critical Care

SN - 1364-8535

M1 - 95

ER -