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The Best Performance of MICU

The Best Performance of MICU. Department of Internal Medicine. Medical Intensive Care Unit (MICU). MICU 68% CCU 32%. Intensivists. Full time intensivists in MICU since 1 April 2005 Semi-close MICU unit Staff ward Initiated ICU organization. Intensivist and MICU organization.

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The Best Performance of MICU

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  1. The Best Performance of MICU Department of Internal Medicine

  2. Medical Intensive Care Unit (MICU) MICU 68% CCU 32%

  3. Intensivists • Full time intensivists in MICU since 1 April 2005 • Semi-close MICU unit • Staff ward • Initiated ICU organization

  4. Intensivist and MICU organization • Full time intensivists • Ward round • Triage, discharge • Teaching and training medical residents

  5. Intensivist and MICU organization • Full time intensivits

  6. Intensivist and MICU organization • MICU protocol/guideline • Drug preparation/infusion guideline • Feeding • Sedation and analgesia • Insulin protocol • Intra-hospital transport guideline

  7. ICU audit

  8. ICU performance measurement • Outcome -> mortality (ICU, hospital) -> length of stay • Access of care • Complication rate • … Outcome -> Mortality Standard Mortality Ratio (SMR)

  9. ICU performance • Severity score and organ dysfunction score in ICU of Songklanagarind hospital • Prospective observational cohort study • Inclusion criteria Patients > 15 yrs who admitted at ICU during July 2004- Aug 2008 • Exclusion criteria - ICU LOS < 4 hrs - Re-admission

  10. ICU performance: Intensivists • Exclude ACS and rhythm disturbance patients (likely CCU patients) • Acute Physiology and Chronic Health Evaluation II (APACHE II) • Simplified Acute Physiology Score II (SAPS II)

  11. Standard Mortality Ratio (SMR) • Standard mortality ratio (SMR)= observe/predict mortality SMR < 1 good ICU performance • International ICU comparison • Comparison of hospital • ICU evaluation

  12. Aug

  13. Aug

  14. Mortality Aug

  15. SMR by APACHE II 0.95 (0.90-0.99) Mayo Clinic (Mayo Clin Proc 2005) 0.93 (0.84-1.02) England (ICM 2003) - Aug

  16. SMR by SAPS II 1.12 (0.92-1.32) Austria (ICM 2000) 0.92 (0.83-1.01) England (ICM 2003) 0.84 (0.82-0.85) French (2006) Aug

  17. Conclusion • Intensivists could improved ICU organization and performance • Further assess in other ICU performance - LOS, adjust LOS ratio - delay admission, ER waiting times - readmissions, infection control.

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