ICU quality and management tools

Intensive Care Unit (ICU) quality and management tools refer to a range of strategies, technologies, and practices aimed at improving patient outcomes, operational efficiency, and safety within the Intensive Care Unit (ICU).

Quality tools include:

• Medical guidelines, including checklists (items rated as yes/no/not applicable)
• Templates for goal setting or structured communication (a more open format than checklists, templates provide the opportunity to add free text responses with items as prompts)
• Care bundles, including ABCDE(F) bundle (Assess, prevent and manage pain, Both spontaneous awakening trials and spontaneous breathing trials, Choice of analgesia and sedation, Delirium assessment, prevention and management, Early mobility and exercise, Family engagement and empowerment)

Medical scoring systems can be used to describe ICU populations and explain their different outcomes. Examples include:

• APACHE II
• SAPS II
• SAPS III
• Mortality Probability Model (MPM)

Physical tools include:

• Monitoring (medicine), which may provide data for analysis of ICU performance.

Examples of severity assessment tools:

• Pneumonia severity index (PSI) or PORT score)
• CURB65 score
• CRB65 score
• American Thoracic Society (ATS) 2001 criteria
• Infectious Disease Society of America/ATS (IDSA/ATS) 2007 criteria
• Panic Disorder Screener (PADIS) guidelines

Risk stratification tools examples:

• Early warning score such as the Modified Early Warning Score (MEWS), to predict ICU readmission, and the Pediatric early warning signs (PEWS) score
• Minimizing ICU Readmission (MIR) score, to predict patient death or ICU readmission.
• Sabadell score, which predicts hospital mortality after ICU discharge.
• Stability and Workload Index for Transfer (SWIFT) score and the Frost nomogram, to predict ICU readmission.

• APACHE II
• SAPS III
• Intensive care medicine
• Intensive care unit

• Gallesio, Antonio O.; Ceraso, Daniel; Palizas, Fernando (July 2006). "Improving Quality in the Intensive Care Unit Setting". Critical Care Clinics. 22 (3): 547–571. doi:10.1016/j.ccc.2006.04.002. ISSN 1557-8232. PMID 16893740.
• Garland, Allan (June 2005). "Improving the ICU: part 1". Chest. 127 (6). American College of Chest Physicians: 2151–64. doi:10.1378/chest.127.6.2151. PMID 15947333.
• Garland, Allan (June 2005). "Improving the ICU: part 2". Chest. 127 (6). American College of Chest Physicians: 2165–79. doi:10.1378/chest.127.6.2165. PMID 15947334.
• Knaus, William A.; Draper, Elizabeth A.; Wagner, Douglas P.; Zimmerman, Jack E. (October 1985). "APACHE II: a severity of disease classification system". Critical Care Medicine. 13 (10): 818–29. doi:10.1097/00003246-198510000-00009. PMID 3928249.
• McMillan, Tracy R.; Hyzy, Robert C. (February 2007). "Bringing quality improvement into the intensive care unit". Critical Care Medicine. 35 (2 Suppl). Society of Critical Care Medicine and Lippincott Williams & Wilkins: S59 – S65. doi:10.1097/01.CCM.0000252914.22497.44. PMID 17242607.
• The Epimed Monitor ICU Database®: a cloud-based national registry for adult intensive care unit patients in Brazil. Zampieri FG, Soares M, Borges LP, Salluh JIF, Ranzani OT.Rev Bras Ter Intensiva. 2017 Oct-Dec;29(4):418-426. doi: 10.5935/0103-507X.20170062. Epub 2017 Nov 30.
• New perspectives to improve critical care benchmarking. Salluh JIF, Chiche JD, Reis CE, Soares M.Ann Intensive Care. 2018 Feb 2;8(1):17. doi: 10.1186/s13613-018-0363-0.
• How to evaluate intensive care unit performance during the COVID-19 pandemic. Zampieri FG, Soares M, Salluh JIF.Rev Bras Ter Intensiva. 2020 Jun;32(2):203-206. doi: 10.5935/0103-507x.20200040. Epub 2020 Jul 13.

• APACHE II Score online
• SAPS II Scoring Sheets and Database