Organizational Changes in a Single Intensive Care Unit Affect Benchmarking
Authors: Arthur R.H. van Zanten
Journal: Annals of Internal Medicine (2004)

Letters20 April 2004Organizational Changes in a Single Intensive Care Unit Affect BenchmarkingArthur R.H. van Zanten, MD and Kees H. Polderman, MD, PhDArthur R.H. van Zanten, MDFrom Gelderse Vallei Hospital, 6710 HN Ede, and Free University Medical Center, 1007 MB Amsterdam, the Netherlands. and Kees H. Polderman, MD, PhDFrom Gelderse Vallei Hospital, 6710 HN Ede, and Free University Medical Center, 1007 MB Amsterdam, the Netherlands.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-8-200404200-00037 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Background: Rosenberg and colleagues (1) described effects of organizational aspects and case-mix differences among critically ill patients, especially those transferred from other hospitals, on efficiency and quality benchmarking systems. Even in a setting with optimal diagnostic-based case-mix adjustment and severity-of-illness scoring based on Acute Physiology and Chronic Health Evaluation III (APACHE III), the authors observed that benchmarking outcomes were not adequately adjusted for transferred patients. This resulted in misleading assessments of efficiency and quality benchmarking performance (1).One of the important limitations acknowledged by the authors was that their data came from a single center and thus ...References1. Rosenberg AL, Hofer TP, Strachan C, Watts CM, Hayward RA. Accepting critically ill transfer patients: adverse effect on a referral center's outcome and benchmark measures. Ann Intern Med. 2003;138:882-90. [PMID: 12779298] LinkGoogle Scholar2. Critical care services and personnel: recommendations based on a system of categorization into two levels of care. American College of Critical Care Medicine of the Society of Critical Care Medicine. Crit Care Med. 1999;27:422-6. [PMID: 10075071] CrossrefMedlineGoogle Scholar3. Polderman KH, Thijs LG, Girbes AR. Interobserver variability in the use of APACHE II scores. Lancet. 1999;353:380. [PMID: 9950452] CrossrefMedlineGoogle Scholar4. Polderman KH, Girbes AR, Thijs LG, Strack van Schijndel RJ. Accuracy and reliability of APACHE II scoring in two intensive care units. Problems and pitfalls in the use of APACHE II and suggestions for improvement.Anaesthesia. Anaesthesia. 2001;56:47-50. [PMID: 11167435] CrossrefMedlineGoogle Scholar5. Polderman KH, Jorna EM, Girbes AR. Inter-observer variability in APACHE II scoring: effect of strict guidelines and training. Intensive Care Med. 2001;27:1365-9. [PMID: 11511950] CrossrefMedlineGoogle Scholar6. Polderman KH, Christiaans HM, Wester JP, Spijkstra JJ, Girbes AR. Intra-observer variability in APACHE II scoring. Intensive Care Med. 2001;27:1550-2. [PMID: 11685351] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Arthur R.H. van Zanten, MD; Kees H. Polderman, MD, PhDAffiliations: From Gelderse Vallei Hospital, 6710 HN Ede, and Free University Medical Center, 1007 MB Amsterdam, the Netherlands. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAccepting Critically Ill Transfer Patients: Adverse Effect on a Referral Center's Outcome and Benchmark Measures Andrew L. Rosenberg , Timothy P. Hofer , Cathy Strachan , Charles M. Watts , and Rodney A. Hayward Metrics Cited byComparison of community and referral intensive care unit patients in a tertiary medical center: Evidence for referral bias in the critically ill*Changes in Intensive Care Unit Performance Measures Associated With Opening a Dedicated Thoracic Surgical Progressive Care UnitUsing risk adjustment systems in the ICU: avoid scoring an "own goal"The influence of missing components of the Acute Physiology Score of APACHE III on the measurement of ICU performanceEffect of training and strict guidelines on the reliability of risk adjustment systems in paediatric intensive care 20 April 2004Volume 140, Issue 8Page: 674-675KeywordsClinical trialsCritical careDiagnosis related groupsHealth care qualityInformation technologyIntensive care unitsMortalityVentilators ePublished: 20 April 2004 Issue Published: 20 April 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...