Assessing the efficiency of the admission process to a critical care unit: Does the literature allow the use of benchmarking?

Abstract

Objectives: To determine the ability of the current literature to supply appropriate data for benchmarking admission practice to a multidisciplinary critical care unit. Design: Retrospective review of data collected prospectively on a cohort of 614 patients and a systematic review of the literature. Setting: A 30-bed multidisciplinary critical care unit at a university teaching hospital. Patients: Consecutive admissions to the critical care unit over a 6-month period. Interventions: None. Measurements and results: For each patient, demographic data and admitting diagnosis were recorded on admission. Information necessary to calculate the Acute Physiology and Chronic Health Evaluation II and Therapeutic Intervention Scoring System (TISS) scores were collected daily. TISS variables were categorized as 'active' or 'non-active' treatment variables. Patients were then identified on a daily basis as receiving or not receiving active treatment. A review of the literature, using MEDLINE and the search term 'Therapeutic Intervention Scoring Index' (as a textword), was conducted to identify studies that had similarly divided their patients. Using the method of benchmarking, the proportion of patients admitted who received active treatment during their stay in the critical care units was compared between the index critical care unit and those in the literature. A greater proportion of the patients admitted to our unit received active treatment (97.7%)when compared to other studies in the literature (20-66%). However, a number of potential confounding factors were present, such as the availability of intermediate care units, overnight recovery room ventilation, and critical care bed availability between the index critical care unit and those described in the literature. Conclusions: The current literature does not provide adequate data on critical care unit admission practices to allow useful application of the method of benchmarking. There is a need for publicly accessible large databases to allow individual critical care units to determine their level of efficiency when compared to similar institutions.