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Quality assessment in intensive care units: proposal for a scoring system in terms of structure and process

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Abstract

Objective

We present a score for assessing the quality of ICU care in terms of structure and process, based on bibliographic review, expert consultations, field test, analysis, and final consensus, and analyze its initial application in the field.

Design and setting

This feasibility and observational study was conducted within the framework of a French regional clinical research project (NosoQual); 40 ICUs were visited and assessed between November 2002 and March 2003 according to standardized procedures.

Measurements and results

The grid consisted of 95 variables. The overall score derived from seven independent quality dimensions: human resources, architecture, safety and environment, management of documentation, patient care management, risk management of infections and evaluation, and surveillance. The average level of achievement of the scores varied from 48% to 63% of theoretical maxima. Variability in the individual dimensional subscores was greater than that of the overall score (CV = 0.15).

Conclusions

Evaluation this scoring system encounters the limitation of the absence of a “gold standard.” However, this is counterbalanced by the rigorous design methodology, the characteristic strengths of the quality dimensions. The survey also highlights also feasibility and the potential interest for specific tools for the assessment of ICUs.

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Acknowledgements

Participating ICUs from the REA Sud-Est network, L. Aysac and B. Tressières from the C.CLIN Sud-Est, the expert consultation group, investigation teams, Hospices Civiles de Lyon, CHRU de Montpellier, CHU de Nice and the French Ministry of Health. The ICUs participating in the survey were the following: Département Réanimation Urgences-SMUR, Centre Hospitalier, Ales; Réanimation polyvalente, Centre Hospitalier Juan-les-Pins, Antibes; Réanimation polyvalente, Centre Hospitalier, Arles; Réanimation, Centre Hospitalier Général, Aubagne; Réanimation, Centre Hospitalier, Aubenas; Réanimation médico-chirurgicale, Centre Hospitalier du Dr Récamier, Belley; Réanimation, Infirmerie Protestante, Caluire; Réanimation polyvalente, Centre Hospitalier, Cannes; Réanimation, Centre Hospitalier Antoine Gayraud, Carcassonne; Réanimation, Clinique du Parc, Castelnau-le-Lez; Réanimation polyvalente, Centre Hospitalier, Chambery; Réanimation polyvalente, Centre Hospitalier, Draguignan; Réanimation, Centre Hospitalier Fréjus–St. Raphaël, Fréjus; Réanimation polyvalente, Centre Hospitalier, Gap; Réanimation cardio-vasculaire et thoracique, Centre Hospitalier Universitaire, Grenoble; Réanimation chirurgicale 1 (URC), Centre Hospitalier Universitaire, Grenoble; Réanimation, Centre Hospitalier, La ciotat; Réanimation–Pavillon N, CHU Lyon–Hôpital Edouard Herriot, Lyon; Soins Intensifs Post-Opératoires–Unité 800, CHU Lyon–Hôpital Pierre Wertheimer, Lyon; Réanimation, Institut Paoli Calmette, Marseille; Réanimation, Clinique Vert Coteau, Marseille; Réanimation polyvalente, APHM–Hôpital Nord, Marseille; Réanimation, Centre Hospitalier, Martigues; Réanimation / USI, Polyclinique Saint Jean, Mimet; Réanimation polyvalente, Centre Hospitalier, Montelimar; Département d'Anesthésie Réanimation DAR-C, CHU Montpellier–Hôpital Gui de Chauliac, Montpellier; Département d'Anesthésie Réanimation DAR-B, CHU Montpellier–Hôpital Saint Eloi, Montpellier; Réanimation médicale et assistance respiratoire, CHU Montpellier–Hôpital Gui de Chauliac, Montpellier; Réanimation polyvalente, Centre Hospitalier, Narbonne; Réanimation polyvalente, CHU Nice–Hôpital Saint Roch, Nice; Réanimation, CHU Nice–Hôpital Archet 2, Nice; Réanimation, Centre Hospitalier, Privas; Réanimation polyvalente, Centre Hospitalier de Roanne, Roanne; Réanimation médicale, CHU Saint-Étienne–Hôpital Bellevue, Saint Etienne; Réanimation polyvalente, CHU Saint-Étienne–Hôpital Nord, Saint Etienne; Réanimation médico-chirurgicale, Hôpitaux du Pays de Mont-Blanc, Sallanches; Réanimation, Hôpitaux du Léman–Hôpital Georges Pianta, Thonon les Bains; Réanimation polyvalente, Hôpital Font-Pré, Toulon; Réanimation médico-chirurgicale, Centre Hospitalier Lucien Hussel, Vienne; Réanimation polyvalente, Centre Hospitalier, Villefranche sur Saone.; Réanimation, Centre Hospitalier Princesse Grace, Monaco; Réanimation chirurgicale–Réa Nord, CHU Lyon–Centre Hospitalier Lyon Sud, Lyon

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Authors and Affiliations

  1. Laboratoire d’Épidémiologie et Santé Publique, Université de Lyon, 8 avenue Rockefeller, 69373, Lyon Cedex 08, France

    Josette Najjar-Pellet

  2. Réanimation Médicale & Assistance Respiratoire, CHRU Montpellier-Université Montpellier 1, 80 avenue Augustin Fliche, 34295, Montpellier Cedex 5, France

    Olivier Jonquet

  3. Coordination Hospitalière Prélèvements et Greffes d’Organes et de Tissus, Hôpital de Cimiez, CHU de Nice, 4 avenue Reine Victoria BP 1179, 06003, Nice Cedex 1, France

    Patrick Jambou

  4. C.CLIN Sud-Est and Laboratoire d’Épidémiologie et Santé Publique, Université de Lyon, 8 avenue Rockefeller, 69373, Lyon Cedex 08, France

    Jacques Fabry

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  1. Josette Najjar-Pellet
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  2. Olivier Jonquet
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  4. Jacques Fabry
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Correspondence to Josette Najjar-Pellet.

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Najjar-Pellet, J., Jonquet, O., Jambou, P. et al. Quality assessment in intensive care units: proposal for a scoring system in terms of structure and process. Intensive Care Med 34, 278–285 (2008). https://doi.org/10.1007/s00134-007-0883-9

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