The Nepean Intensive Care Web Site

http://www.nepeanicu.org

Data Management in Nepean ICU

The Nepean Intensive Care Unit maintains a commitment to the accurate collection and utilisation of data within the Intensive Care Unit. A small team exists within the ICU headed by a Data Manager who has a substantial background in Intensive Care nursing. Not simply a team which collects data, the team uses the data to assist with the management of resources and planning within the ICU. The Data Management Team aims to utilise patient data as a management and research tool, to actually ask questions of the data, identify quality issues and look for areas which show room for improvement.

The work of the Data Management Team is varied but to give some idea of the day to day routine 3 current projects are described here: the upkeep and utilisation of the AORTIC Database, the running of the monthly Morbidity and Mortality Meeting and the collection and utilisation of the ‘Cleared for the Ward’ figures. The team is involved in many other areas but this will give an idea of the typical work.

The AORTIC Database

In 1995 the Nepean Hospital Intensive Care Unit started contributing data to the Australian & New Zealand Intensive Care Society (ANZICS) database. This database has been in existence in various forms since 1990 when the decisions was made by ANZICS to implement a ‘National Patient Database’ to collect national information about ICU resource allocation, patient demographics and patient outcome.

This database has been funded by the NSW Health Department as part of their stated need to ‘develop a comprehensive and ongoing intensive care database and patient level dataset which is necessary to ensure and facilitate better practice in the planning and provision of intensive care services. Systematic data collection and analysis are needed to support ongoing clinical review and effective resource utilisation within the units’. The database is now called AORTIC (Australian Outcomes Research Tool for Intensive Care). The database takes the raw data and makes all the necessary calculations to provide the Acute Physiology, Age, & Chronic Health Evaluation (APACHE III) score for each patient.

The AORTIC Database also generates routine reports, which are submitted electronically on a regular basis to the national database run by ANZICS. In return the Nepean ICU receives reports from this main database, which gives a comparison between the Nepan APACHE scores, outcomes, length of stay, age distribution of patients etc. and that of other contributing hospitals.

Morbidity & Mortality Meetings

The Nepean Intensive Care Unit gives a very high priority to the monthly Morbidity & Mortality Meetings, and the Data Management team is an integral part of this process. A senior medical officer will have reviewed all the deaths for the previous month and will present all these cases for review by medical and nursing staff of the Intensive Care Unit.The Data Management team will assemble the required Medical Records for these patients and will ensure that each patient has an Apache score.

The Data Manager will also present a statistical analysis of these deaths as well as present admission, acuity of illness and length of stay figures of all patients for the entire month. Other information that may be presented during the Data Management presentation will include comparisons of Apache scores with previous months and years, comment upon the overall Standardised Mortality Ratio (SMR) currently and for previous time periods, numbers of patients ventilated and the time periods of ventilation as well as other information as required.

The Data Manager is also responsible for collecting and reviewing any incidents within the Intensive Care Unit that potentially or actually compromise patient care. Examples of such incidents that are collected are unplanned readmissions to the Intensive Care Unit, inability to admit appropriate patients to the Intensive Care Unit, unplanned extubations, pneumothoraces post central line insertion and many others. This information is collected by the Data Management team, categorised and stored in an Excel Workbook and then analysed and presented at the Morbidity and Mortality Meeting. It is the overall responsibility of the Data Management team to write minutes for the meeting as well as ensure that appropriate remedial action, if required, is undertaken.

Cleared for the Ward

The overall aim of this review is to monitor aspects of bed usage in the ICU. This is an ongoing process as part of our quality improvement activities at a local level within the ICU and as part of the quality in ICU initiatives as set by the Intensive Care Services Plan – Adult Services, Year 2001. This plan specifies that the Intensive Care Unit should have the ability to transfer patients to a ward bed within 6 hours of assessment as ‘ready to discharge’ by the Intensive Care Specialist.

Figures already collected indicate that the Nepean ICU is consistently not meeting this benchmark and the phenomenon of 'exit block' from the Intensive Care is now a well recognised problem. Data indicates that a great percentage of our CFW patients remain in the ICU for greater than the six hours specified. In addition a significant percentage remain in the ICU for greater than 24 hours after being declared CFW.

The Data Management team collects this information in Excel Workbooks and the information is widely disseminated within the Intensive Care Unit itself as well as promulgated within hospital and area management groups.The ultimate aim of collecting these figures is to demonstrate and track inefficient usage of Intensive Care beds and consequently both save the organisation money and ensure efficient use of an expensive resource.

Further Information

The Data Management team operates in several other areas within the Intensive Care Unit. For more detail about these areas and perhaps greater depth of information on areas already described please feel free to contact the Data Management team by email at: phillid@wahs.nsw.gov.au