A collaborative meeting between VPICU, NACHRI and members of the National Outcomes Center was held in Milwaukee on May 1st - hosted by Tom Rice, M.D., the director of the Division of Critical Care at Children’s Hospital of Wisconsin. The major goal of the meeting was strategic planing for and review of the VPICU database. Assessment of ‘what have we got” and ensuring that the current VPICU Performance System (VPS) will meet our needs, as well as what to do with it and how we envision it being used, became the agenda. Prime question to be answered: is the VPS a tool to support multi site research studies?
Those in attendance included: Randall C. Wetzel, MB, MS Bus., FAAP, FCCM, Director of the Laura P. and Leland K. Whittier Virtual PICU, Ramesh Sachveda Director of the National Outcomes Center, Tom Rice, Mary Gorman, Vice President, NACHRI, Education, Operations and Management Information Services, Matt Scanlon, M.D. pediatric intensivist at Children’s Hospital of Wisconsin, Steve Pon, M.D. pediatric intensivist from Cornell, Leslie Sedehi, VPICU database specialist and Barry Markowitz, M.D. pediatric intensivist, St. Louis Children’s Hospital.
Beginning with an overview of the work of the National Outcomes Center to date, the team gained a clear understanding of the concept of process and outcomes with regard to quality. Collaboratively we are in agreement that the importance of a valid database is the first step in quality improvement. It guides selection of quality indicators, must be risk adjusted and provide outcome measures in order to be effective.
So, why do this? Our overriding mission remains to facilitate UNDERSTANDING OF, IMPROVEMENT OF, and the SHARING OF INFORMATION RELATED TO our care of critically ill children. Some of the independent drivers leading to this mission include:
- Support and objectivity for continuous process improvement effort in critical care, thus a cornerstone of the QA, PI process.
- Regulatory pressures with JCAHO and state and local requirements for objectively understanding the care we give.
- Eventually and ultimately benchmarking will occur and we will need to have comparable data.
- Understanding our local practice, the demographics, the problems, the patient level statistics and outcomes is obviously important, not only for what it tells us about our practice but also for enabling us to follow that practice over time in a responsive fashion, something that large hospital databases, written records and some one else’s data won’t allow us to do at the unit level.
- Research and data mining with knowledge discovery in databases underlies continuous practice improvement and is the only way we can improve our efficiency and thus competitiveness in the market place.
The VPS is an excellent vehicle for meeting the challenges ahead, our data is valid, verified and clean, shared nationally and it is a data base designed by intensivists to understand intensive care.
Central to any discussion of measuring and improving quality of care for critically ill children is a common method for adjusting severity of illness. The need for an objective score for comparing data, whether the outcomes are mortality, POPC, PCPC, dollars spent, LOS, or whatever else one might want to measure, is vital. Without some way of rendering the individual datasets comparable [both among various units as well as internally over time], there would be no way to define ‘better’ or worse’, OR ‘needs improvement’, ‘needs to be understood’ so that improvement can occur.
In our discussions, the ready public access, ease of scoring, timeliness and ability to score all patients, international validity and acceptance, zero expense and fair comparability with the PRISM scores supported the use of PIM. On the other hand the reliability, reputation and acceptability of PRISM III supported its selection.
After lengthy consideration, it was suggested that NACHRI and the VPICU strongly encourage the VPS users to employ PIM scoring. It was felt that this would not add significant time to those not currently doing so, nor prevent them from continuing to use PRISM II or III if preferred. The availability of the VPS export tool to send data to PICUes would readily provide the ability for users wishing to use PRISM III to continue.
HIPAA and its impact across the nation on data collection and research publication is a topic for serious consideration among all health care institutions. The possibility that institutions wishing to participate in aggregate data collection and comparison will interpret this act differently and create policies that hinder participation is a very real one. NACHRI will be making a public statement about HIPAA and databases (especially the VPS) for our users in the next few weeks.
A question remains of how to manage the critically ill child with overriding cardiac complications. We all agreed that post operative children for congenital heart disease surgery are a unique subset of patients and that the current scoring systems are not adequate to measure their severity of illness.
The day ended with a celebratory evening hosted at the home of Dr. and Mrs. Ramesh Sachveda, enjoyed by all. |
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