Effect of ICU Quality Control and Secondary Analysis: A 12-Year Multicenter Quality Improvement Project.

Abstract

Background: China's aging population and increasing demand for critical care pose significant challenges to ICU quality improvement (QI). This study evaluates the impact of a 12-year multicenter QI initiative on ICU performance and patient outcomes in the context of resource constraints.

Methods: A pre-post intervention study was conducted across 75 ICUs in Beijing from January 2011 to December 2022. Key interventions included the establishment of QI teams, infection prevention protocols, pain and sedation management, nutritional support, and early mobilization strategies based on the PDCA cycle, as well as regular training and feedback. Primary outcomes included ICU mortality, standardized mortality ratio (SMR) (ratio of observed to expected deaths, adjusted for risk), and healthcare-associated infections (HAIs), such as VAP, CLABSI, and CAUTI rates. Secondary outcomes included unplanned extubation rates, reintubation within 48 hours, and ICU readmission rates within 48 hours.

Results: Analysis of 425,534 patient records from 5396 reports revealed significant improvements. The proportion of ICU admissions among total inpatients increased from 4.1% in 2011 to 7.3% in 2022 (P < 0.001), and the proportion of patients with APACHE II scores ≥15 rose from 52.0% to 67.5% (P < 0.001). Compliance with 3-hour and 6-hour sepsis bundles increased (P < 0.001), and microbiological testing before antibiotic administration also improved (P < 0.001). Outcome indicators showed significant reductions in CRBSI and CAUTI rates (P < 0.001), ICU mortality (P < 0.001), and SMR (P < 0.001). VAP rates decreased from 6.29 to below 5.0 per 1000 ventilator days. ICU readmission rates and unplanned transfers slightly increased but remained low (P > 0.05).

Conclusion: The study highlights the importance of addressing structural, process, and outcome indicators for effective ICU management. Continued monitoring and targeted interventions for high-risk ICUs are essential to sustaining quality improvements.