PICU Quality Dashboard
In any healthcare service, it is important to know how well patients respond to whatever it is that the healthcare service is doing. We do this my measuring things called "Outcomes" or "Outcome Measures". In Paediatric Intensive Care, the main Outcomes that have been used over the past 20 years have been standardised mortality rate (i.e. the actual death rate versus the predicted death rate given the seriousness of the illnesses in the patients), length of intensive care stay and survival at one month after intensive care discharge. We also look at things like rates of hospital-acquired infections to tell us how safe a particular service is. For our service, these data are available from the PICANet and SPSP websites respectively.
Since modern intensive care was established in the 1980s, standardised ICU mortality rates have generally continued to fall. This makes it harder for intensive care units to use mortality rates as a way of measuring how well they are performing, particularly in children's intensive care where the adjusted mortality risk is already quite low.
As mortality continues to get smaller, it becomes less statistically useful as a way of telling how good our service is. Now across the UK, Paediatric Intensive Care Units are beginning to look at using other Outcomes. One promising strategy is to look at the monthly patterns of a range of well-known, common complications of Intensive Care which can make patients stay in PICU longer or require different treatment. We call these complications "Morbidities", and we call this method a "Morbidity Dashboard" or a "Quality Dashboard", because a bit like the dashboard of a car it tells us how all the different parts are performing.
Since 2015 we have been presenting the dashboard data out our internal Quality Review meetings. This approach has already led to interventions that have improved patient care, such as reducing the number of unplanned extubations (breathing tube removals) by creating a nurse-led intervention to replace the tube fixing tapes when they become loose.
PICU Glasgow is at the forefront of this approach, but we are still working out how to apply the data we are collecting - for example: are we measuring the right complications? How exactly do we adjust these patterns for the normal variation in certain diseases?
Once we have learned more about what our data means, we plan to publish the data on this website. We believe a culture of openness is essential to help staff keep our patients safe. There is no point in measuring something if we do not try and learn from it.