Monitoring Intensive Care Unit Performance: Impact of a Novel Individualized Performance Scorecard in Critical Care Medicine – A Mixed-Methods Study Protocol
CCCF ePoster library. Fernando S. 10/02/17; 198158; 17
Dr. Shannon Fernando
Dr. Shannon Fernando
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Monitoring Intensive Care Unit Performance: Impact of a Novel Individualized Performance Scorecard in Critical Care Medicine - A Mixed-Methods Study Protocol

Fernando, Shannon M. MD, MSc1,2; Neilipovitz, David MD1; Sarti, Aimee J. MD1; Rosenberg, Erin MD MHA1; Ishaq, Rabia RN1; Thornton, Mary RN1; Kim, John MD, MEd1

1. Department of Critical Care Medicine, The Ottawa Hospital, Ottawa, Canada; 2. Department of Emergency Medicine, The Ottawa Hospital, Ottawa, Canada


Background: Patients admitted to a Critical Care Medicine (CCM) environment, including an Intensive Care Unit (ICU), are among the most susceptible to harm, and also account for significant resource utilization. Given this, a strategy to optimize health care provider performance is required. Performance scorecards have been utilized by healthcare institutions for the purposes of monitoring clinical performance and driving quality improvement. Unfortunately, most scorecards use overall outcomes that are hard to attribute to an individual. Furthermore, individuals will often tailor their practice to optimize scorecard variables (so-called “gaming”), instead of patient-centred care. While scorecards have been introduced in CCM to monitor safety, there is no widely-accepted or standardized scorecard that has been utilized for overall CCM performance.
Objectives: We aim to improve quality of care, patient safety, and patient and family experience in CCM practice through the utilization of a standardized, repeatable and multidimensional performance scorecard, designed to provide a continuous review of ICU physician and nurse practice, as well as departmental metrics.  
Methods and Analysis: This will be a mixed-methods, controlled before and after study to assess the impact of a multidisciplinary clinical quality scorecard (specifically designed for CCM). Scorecard metrics were developed through expert consensus and existing literature. Attempts have been made to address “gaming” actions by incorporating multiple, opposing measures (so-called “Balanced Composites”). The study will include 19 attending CCM physicians and approximately 300 CCM nurses. Patient data for scorecard compilation is collected daily from patient bedside flow sheets. Pre-intervention baseline data will be collected for 6 months for each participant. After this, each participant will meet with the Department Head or Nursing Coordinator, at which time they will receive their individualized scorecard measures. Following a 3-month washout period, post-intervention data will be collected for 6 months. The primary outcome will be change in performance metrics (including mortality, ICU length of stay, sedation, pain management, mobility, etc) following the provision of scorecard feedback to subjects. A cost analysis will also be performed. The qualitative portion will include interviews with participants once the intervention phase has been completed. Interviews will be analyzed in order to identify recurrent themes and subthemes, for the purposes of driving scorecard improvement.   
Ethics and Dissemination: The study protocol has been approved by the local research ethics board. Publication of the study results is anticipated in 2018 or 2019. If this intervention is found to improve patient and unit-directed outcomes, with evidence of cost-effectiveness, it would support the utilization of such a scorecard as a quality standard in CCM.

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