Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study

Marie-José Roos-Blom; Ferishta Bakhshi-Raiez; Sylvia Brinkman; M Sesmu Arbous; Roy van den Berg; Rob J Bosman; Bas C T van Bussel; Michiel L Erkamp; Mart J de Graaff; Marga E Hoogendoorn; Dylan W de Lange; David Moolenaar; Jan Jaap Spijkstra; Ruud A L de Waal; Dave A Dongelmans; Nicolette F de Keizer

doi:10.1016/j.jcrc.2023.154461

Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study

Marie-José Roos-Blom
, Ferishta Bakhshi-Raiez
, Sylvia Brinkman
, M Sesmu Arbous
, Roy van den Berg
, Rob J Bosman
, Bas C T van Bussel
, Michiel L Erkamp
, Mart J de Graaff
, Marga E Hoogendoorn
, Dylan W de Lange
, David Moolenaar
, Jan Jaap Spijkstra
, Ruud A L de Waal
, Dave A Dongelmans
, Nicolette F de Keizer

Leiden University Medical Center
Elisabeth-Tweesteden Hospital
National Intensive Care Evaluation Foundation
Maastricht University Medical Center
St. Antonius Hospital
University of Utrecht
Martini Hospital
Amsterdam
Amphia Hospital
National Intensive Care Evaluation, Amsterdam, the Netherlands
Amsterdam Public Health
Department of Medical Oncology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
Onze Lieve Vrouwe Gasthuis
Maastricht UMC+
Department of Pulmonology, Dijklander Ziekenhuis, Purmerend, the Netherlands
St. Antonius Ziekenhuis
Department of Radiology, Isala Ziekenhuis, 8025 AB, Zwolle, The Netherlands
University Medical Center Utrecht
Martini Ziekenhuis
Department of Orthopaedic Surgery, Amsterdam UMC, Amsterdam, Netherlands.
University of Amsterdam
National Intensive Care Evaluation
VU University and Amsterdam Public Health Research Institute
Leiden University
locatie West Previously Sint Lucas Andreas Ziekenhuis
Maastricht University
Dijklander Ziekenhuis
Departments of Surgery and Medical Oncology, Isala, Zwolle, The Netherlands
Utrecht University
Dutch Expertise Centre for Neuro-ophthalmology and MS Centre, Departments of Neurology and Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
Amphia ziekenhuis

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

PURPOSE: To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry.

MATERIALS AND METHODS: We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC).

RESULTS: 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021.

CONCLUSIONS: Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.

Original language	English
Article number	154461
Pages (from-to)	154461
Journal	Journal of critical care
Volume	79
Early online date	2023
DOIs	https://doi.org/10.1016/j.jcrc.2023.154461
Publication status	Published - Feb 2024

Keywords

Humans
Quality Improvement
Pandemics
Pressure Ulcer
Intensive Care Units
Length of Stay
Registries
Hospital Mortality
COVID-19/therapy
Cluster analysis
Quality indicator
Trends

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Roos-Blom, M.-J., Bakhshi-Raiez, F., Brinkman, S., Arbous, M. S., van den Berg, R., Bosman, R. J., van Bussel, B. C. T., Erkamp, M. L., de Graaff, M. J., Hoogendoorn, M. E., de Lange, D. W., Moolenaar, D., Spijkstra, J. J., de Waal, R. A. L., Dongelmans, D. A., & de Keizer, N. F. (2024). Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study. Journal of critical care, 79, 154461. Article 154461. https://doi.org/10.1016/j.jcrc.2023.154461

@article{b2a742792dd3432d9050b48e40ac4f14,

title = "Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study",

abstract = "PURPOSE: To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry.MATERIALS AND METHODS: We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC).RESULTS: 705,822 ICU admissions from 55 (65\%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021.CONCLUSIONS: Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.",

keywords = "Humans, Quality Improvement, Pandemics, Pressure Ulcer, Intensive Care Units, Length of Stay, Registries, Hospital Mortality, COVID-19/therapy, Cluster analysis, Quality indicator, Trends",

author = "Marie-Jos{\'e} Roos-Blom and Ferishta Bakhshi-Raiez and Sylvia Brinkman and Arbous, \{M Sesmu\} and \{van den Berg\}, Roy and Bosman, \{Rob J\} and \{van Bussel\}, \{Bas C T\} and Erkamp, \{Michiel L\} and \{de Graaff\}, \{Mart J\} and Hoogendoorn, \{Marga E\} and \{de Lange\}, \{Dylan W\} and David Moolenaar and Spijkstra, \{Jan Jaap\} and \{de Waal\}, \{Ruud A L\} and Dongelmans, \{Dave A\} and \{de Keizer\}, \{Nicolette F\}",

year = "2024",

month = feb,

doi = "10.1016/j.jcrc.2023.154461",

language = "English",

volume = "79",

pages = "154461",

journal = "Journal of critical care",

issn = "0883-9441",

publisher = "Elsevier BV",

}

Roos-Blom, M-J , Bakhshi-Raiez, F , Brinkman, S, Arbous, MS, van den Berg, R, Bosman, RJ, van Bussel, BCT, Erkamp, ML, de Graaff, MJ, Hoogendoorn, ME, de Lange, DW, Moolenaar, D, Spijkstra, JJ, de Waal, RAL, Dongelmans, DA & de Keizer, NF 2024, 'Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study', Journal of critical care, vol. 79, 154461, pp. 154461. https://doi.org/10.1016/j.jcrc.2023.154461

TY - JOUR

T1 - Quality improvement of Dutch ICUs from 2009 to 2021

T2 - A registry based observational study

AU - Roos-Blom, Marie-José

AU - Bakhshi-Raiez, Ferishta

AU - Brinkman, Sylvia

AU - Arbous, M Sesmu

AU - van den Berg, Roy

AU - Bosman, Rob J

AU - van Bussel, Bas C T

AU - Erkamp, Michiel L

AU - de Graaff, Mart J

AU - Hoogendoorn, Marga E

AU - de Lange, Dylan W

AU - Moolenaar, David

AU - Spijkstra, Jan Jaap

AU - de Waal, Ruud A L

AU - Dongelmans, Dave A

AU - de Keizer, Nicolette F

PY - 2024/2

Y1 - 2024/2

N2 - PURPOSE: To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry.MATERIALS AND METHODS: We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC).RESULTS: 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021.CONCLUSIONS: Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.

AB - PURPOSE: To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry.MATERIALS AND METHODS: We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC).RESULTS: 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021.CONCLUSIONS: Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.

KW - Humans

KW - Quality Improvement

KW - Pandemics

KW - Pressure Ulcer

KW - Intensive Care Units

KW - Length of Stay

KW - Registries

KW - Hospital Mortality

KW - COVID-19/therapy

KW - Cluster analysis

KW - Quality indicator

KW - Trends

UR - https://www.scopus.com/pages/publications/85176426054

U2 - 10.1016/j.jcrc.2023.154461

DO - 10.1016/j.jcrc.2023.154461

M3 - Article

C2 - 37951771

SN - 0883-9441

VL - 79

SP - 154461

JO - Journal of critical care

JF - Journal of critical care

M1 - 154461

ER -

Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study

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