Journal of Postgraduate Medicine, Education and Research

Register      Login

VOLUME 52 , ISSUE 4 ( October-December, 2018 ) > List of Articles

RESEARCH ARTICLE

Quality of Care in Medical Intensive Care Unit: A Study in an Apex Tertiary Care Teaching Hospital of Northern India

Sidhartha Satpathy, Shakti K Gupta

Keywords : Medical intensive care unit, Outcome of care, Quality of care, Simplified acute physiology score II,Critical care

Citation Information : Satpathy S, Gupta SK. Quality of Care in Medical Intensive Care Unit: A Study in an Apex Tertiary Care Teaching Hospital of Northern India. J Postgrad Med Edu Res 2018; 52 (4):171-176.

DOI: 10.5005/jp-journals-10028-1296

License: CC BY-ND 4.0

Published Online: 00-12-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: The endpoint in quality healthcare is evaluating the outcome of care being rendered. In India, the outcome of healthcare provided in intensive care units (ICUs) has not been studied extensively. The study was aimed to observe the outcome of care provided in a medical intensive care unit (MICU) at a tertiary care teaching institution in North India. Materials and methods: The study was descriptive and cross sectional. Medical records of all patients, admitted from January to June 2011, were analyzed to study demographic, morbidity and mortality parameters. Simplified acute physiology score (SAPS II) scoring was calculated to assess the severity of the admitted patients. Results: In medical intensive care unit (MICU) from January to June 2011, 203 patients were admitted, and 51.7% of them were admitted from the emergency department. The mean age of admitted patients was 50.62 years, and 59.3% were males. The majority (83.1%) of the patients required mechanical ventilation with an average of 3.8 ventilator days. Reintubation rate was found to be 16.9%. Bedsore rate in MICU was 9.9% of the total, 63.4% of patients required oxygen administration. Average MICU length of stay was 6.5 days with a readmission rate of 2.9%. Mean and median predicted mortality using SAPS II was 31.21% and 27.30% (range 0.1 to 96.6%) respectively. MICU mortality and Hospital mortality of MICU admitted was calculated to be 45.9% and 52.3% respectively. Mean age of the patients who died was 54.23 (range 13 to 98 years). Bed occupancy of MICU was 93.47%. Conclusion: Sepsis with septic shock was the major cause of mortality. Standardised mortality was found to be 1.47. Clinical significance: This study focuses on the quality of care in an intensive care unit setting, which is not a priority in developing countries like India. There have been so to say negligible literature on the same especially in developing countries. This study will help us identify the various parameters to measure the quality of care.


PDF Share
  1. Department of Health. Quality Critical Care: Beyond Comprehensive Critical Care. London 2005.
  2. Barbieri C, Carson SS, Amaral AC. Year in review 2007: Critical Care–intensive care unit management. Critical Care. 2008 Oct;12(5):229.
  3. Yeolekar ME, Mehta S. ICU care in India-status and challenges. Journal of Association of Physicians of India. 2008 Apr;56(R):221-222.
  4. Garland A. Improving the ICU: part 1. Chest [Internet]. 2005 Jun [cited 2012 Mar 12];127(6):2151-2164.
  5. Braun J, Mende H, Bause H, Bloos F, Kuhlen R, Geldner G, et al. Quality indicators in intensive care medicine: why? Use or burden for the intensivist. GMS Ger Med Sci [Internet]. 2010 [cited 2012 Jun 18];8:1-20.
  6. Thijs L. Continuous quality improvement in the ICU: general guidelines. Intensive Care Med [Internet]. 1997 [cited 2012 Aug 3];125-127.
  7. Ray B, Samaddar D, Todi D. Quality indicators for ICU [Internet]. isccm.org. Mumbai, India; 2009 [cited 2012 Aug 4].
  8. Frutiger A. Quality assurance in intensive care: the situation in Switzerland. Schweiz Med Wochenschr. 1999;129(43):1592-1599.
  9. Watson RS, Angus DC. Assessing Outcomes in Critical Care. J Intensive Care Med [Internet]. 2002 May 1 [cited 2012 Jun 18];17(3):103-111.
  10. Hasibeder WR. Does standardization of critical care work? Curr Opin Crit Care [Internet]. Lippincott Williams and Wilkins (530 Walnut Street, P O Box 327, Philadelphia PA 19106-3621, United States); 2010;16(5):493-498.
  11. Harrison D a, Brady AR, Rowan K. Case mix, outcome and length of stay for admissions to adult, general critical care units in England, Wales and Northern Ireland: the Intensive Care National Audit & Research Centre Case Mix Programme Database. Crit Care [Internet]. 2004 Apr [cited 2012 Apr 19];8(2):R99-111.
  12. Intensive care for the adult population in Ireland: a multicentre study of intensive care population demographics. Crit Care [Internet]. 2008 Jan [cited 2012 Sep 5];12(5):R121.
  13. Berlowitz DR, Wilking SV. Risk factors for pressure sores. A comparison of cross-sectional and cohort-derived data. J Am Geriatr Soc [Internet]. 1989 Nov [cited 2012 Sep 5];37(11):1043- 1050.
  14. The First Annual Report for: The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE). Carlton South VIC; 2008.
  15. Krinsley JS, Reddy PK, Iqbal A. What is the optimal rate of failed extubation? Crit Care [Internet]. 2012 Feb 20;16(1):111.
  16. Vashishth I. Intensive Care Unit Utilization. Panjab University, India; 2010.
  17. Department of Intensive Care Services 2010 Annual Report. Saudi Arabia; 2010.
  18. Madani N, Rosenthal VD, Dendane T, Abidi K, Zeggwagh AA, Abouqal R. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco: Findings of the International Nosocomial Infection Control Consortium (INICC). Int Arch Med. 2009; 7:1-7.
  19. Rosenberg a. L. Patients Readmitted to ICUs* : A Systematic Review of Risk Factors and Outcomes. Chest [Internet]. 2000 Aug 1 [cited 2012 Apr 2];118(2):492-502.
  20. Chen LM, Martin CM, Keenan SP, Sibbald WJ. Patients readmitted to the intensive care unit during the same hospitalization: clinical features and outcomes. Crit Care Med [Internet]. 1998 Nov [cited 2012 Sep 5];26(11):1834-1841.
  21. Cooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE. Are readmissions to the intensive care unit a useful measure of hospital performance? Med Care [Internet]. 1999 Apr [cited 2012 Sep 5];37(4):399-408.
  22. Strand K, Walther SM, Reinikainen M, Ala-Kokko T, Nolin T, Martner J, et al. Variations in the length of stay of intensive care unit nonsurvivors in three Scandinavian countries. Crit Care [Internet]. Bio Med Central Ltd; 2010 Jan [cited 2012 Jun 18];14(5):R175.
  23. Degoricija V, Sefer S, Kujundziæ-Tiljak M, Gjurasin M. Intensive care units in Croatia: 2001 survey. Croat Med J [Internet]. 2002 Dec;43(6):713-721.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.