Application of the Australian Council on Healthcare Standards clinical markers of quality of care to the ICU of an Indian tertiary referral hospital

The Australian Council on Healthcare Standards (ACHS) used three clinical markers to evaluate quality of care in Intensive Care. They were, one, unplanned readmission to the Intensive Care Unit (ICU) within 48 hours of transfer, two, incidence of pneumothorax associated with central venous catheter (CVC) insertion or attempted insertion in ICU and three, incidence of unplanned extubation (UE) of endotracheal tube (ETT) per intubated day. We recorded the incidence of these clinical markers in our ICU, in 922 patients over a six month period and compared this with those recorded in Australia. We recorded a readmission rate of 1.04%, which was similar to that of 1.62% noted by the ACHS. We recorded a CVC associated pneumothorax of 2.73%, which was not statistically significantly higher than the 1.27% recorded by the ACHS. We did not have a single episode of UE in the 6 months study period while the ACHS reported a significantly higher rate of 0.37% per intubated day. These quality marker incidences were associated with an overall crude mortality of 17.8% and with Standardized Mortality Ratios (SMR) of 0.75 by SAPS II and 0.57 by APACHE II.