Pediatric Intensive Care Databases for Quality Improvement

Abstract

The availability and breadth of collected data has grown exponentially in pediatric critical care medicine. This growth is driven by the practitioners' desire to understand and improve practice. In this manuscript, the author details the registry design factors that must be considered to meet quality improvement and safety needs in pediatric critical care units. The challenges to maintain a high standard database and data on health care delivery performances using the VPS registry data are provided.

Keywords: children; electronic databases; intensive care; quality improvement.

Fig. 1

This plot represents standardized length of stay ratios (SLOSRs) for individual intensive care units (ICUs) caring for cardiac patients plotted from lowest on the left to highest. SLOSRs greater than 1.00 indicate a greater than average length of stay adjusted for severity of illness. This plot also shows SLOSRs for cardiac surgical patients cared for in mixed and dedicated cardiac ICUs (CICUs). The average for all ICUs was 1.04 and good discrimination among units can be seen. (Figure courtesy of Aaron Katch and Dr. Irina Kukuyeva, VPS analytic team.)

Fig. 2

This graph demonstrates the standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) for the top 25 diagnoses in cardiac surgical patients. Except for atrial septal defects (ASDs) and ventricular septal defects (VSDs) (which had no mortalities), the SMRs are not different from one demonstrating that performance is reliable across multiple cardiac diagnoses. AVC, atrioventricular canal; AVSD, atrioventricular septal defect; CAVSD, complete AVSD; PA, pulmonary artery; PDA, patent ductus arteriosus; RV, right ventricle; STS, Society of Thoracic Surgeons; TAPVC, total anomalous pulmonary venous connection; TCPC, total cavopulmonary connection; TOF, tetralogy of Fallot. (Figure courtesy of Aaron Katch and Dr. Irina Kukuyeva, VPS analytic team.)

Fig. 3

This graph represents standardized mortality ratios (SMRs) for each intensive care unit (ICU) plotted against standardized length of stay ratios (SLOSRs), thus demonstrating combined measures of efficacy and efficiency. Clearly ICUs in quadrant 1 have both lower mortality and shorter length of stay (LOS) adjusted for severity of illness than those in the other quadrants. In addition, quadrant 4 has both high mortality and excessive LOS, indicating poorer performing units. VPS, Virtual Pediatric Systems. (Figure courtesy of Aaron Katch and Dr. Irina Kukuyeva, VPS analytic team.)

Fig. 4

A standard funnel plot demonstrating the relationship between the number of cases annually treated by an individual general intensive care unit (ICU) and the standardized mortality ratio (SMR). Outliers with worse performance are seen in the smaller ICUs and outliers with better performance are seen in the larger ICUs. CI, confidence interval; PRISM, pediatric risk of mortality. (Figure courtesy of Aaron Katch and Dr. Irina Kukuyeva, VPS analytic team.)