Description of trends in the course of illness of critically ill patients. Markers of intensive care organization and performance

Objective. To identify objective trends of the course of illness that might be used as benchmarks in the auditing of the organization/performance of Intensive Care Units (ICU). Design. Retrospective analysis. Patients and setting. A group of 12,615 patients and 55,464 patient-days prospectively collected in 89 ICUs of 12 European countries. Methods. The complexity of daily care in the ICU was classified as high (HT) or low (LT), according to six activities registered in NEMS, a daily therapeutic index for ICUs. Results. Six trends of clinical course were identified: LT during the whole ICU stay (5,424 patients, mortality 1.8%); HT (3,480 patients, mortality 30.4%); HT followed by LT (2,781 patients, mortality 2.8%); LT followed by HT (197 patients, mortality 39.1%); finally, LT/HT/LT in 298 patients (mortality 10.5%); and HT/LT/HT (mortality 20.1%) in 438 patients. A group of 930 patients had the complexity of treatment increased (mortality 21.1%) and 3,711 patients received both treatments. Low-care before high-care periods had a mean duration of 2.2±3.5 days, low-care after high-care 2.7±3.1 days, and between two high-care periods 2.1±2.2 days. A group of 1,538 'surgical scheduled' patients only received LT, whereas 2,231 received HT (whether or not exclusively). Overall ICU mortality rate was low (3%) and the length of stay short, regardless of diagnosis and complexity of care received. Conclusions. The use of therapeutic indexes help to classify the daily complexity of ICU care. The classification can be used as an indicator of clinical performance and resource utilization. Keywords. ICU - Level of care - Use of resources - Benchmarking - Outcome - Quality control