INTENSIVE CARE A:14 Mortality after treatment at intensive care units Measure
Risk-adjusted mortality 30 days after arrival at an intensive care unit (ICU) in 2007
Description
Mortality was calculated in accordance with the standardised mortality ratio (SMR). The SMR is the ratio between observed mortality within 30 days after arrival at an ICU and expected risk-adjusted mortality. Observed mortality = Number of deaths within 30 days after start of a care event at an ICU. The number of deaths was followed up each week through the Swedish Population Address Register Board (SPAR). Expected mortality = number of expected deaths according to the Acute Physiology and Chronic Health Evaluation (APACHE). Calculated as the total mortality risk for all intensive care patients with complete risk adjustment.
Method of measurement
For each care event, actual mortality is captured through SPAR. Risk was adjusted in accordance with the APACHE II system modified for Swedish conditions (Swedish APACHE). The Swedish APACHE risk adjustment system includes age, chronic disease, type of acute disease (reason for admission), severity of the acute disease and operated status. The risk of death within 30 days (0.01–0.99) was calculated on the basis of these data. The indicator includes intensive care patients treated at ICUs that were enrolled in the Swedish Intensive Care Register (SIR) and that submitted data. The data were obtained from the databases of each ICU as well as central coordination with SPAR once a week. The regional breakdown was based on the location of the clinic rather than the patient’s region of domicile.
Data sources
Swedish Intensive Care Register (SIR)
Sources of error
Many factors affect the SMR. For instance, the occurrence of those who decline or drop out of treatment in intensive care affects the SMR by increasing the number of deaths. The model for risk adjustment is also of great importance. Incomplete or erroneous data collection can affect the SMR. Dropout for the country as a whole was more than 16% for the 2007 calendar year. There were no data for 5 regions. Dropout in 2007 per ICU varied from 0% to 56%.
A:15 Readmission to intensive care units Measure
Percentage of patients readmitted on an unscheduled basis to the same ICU within 72 hours in 2007
Description
The indicator describes the number of patients in 2007 who were readmitted to the same ICU within 72 hours for the same diagnosis. Numerator: Number of intensive care events for which the patient was readmitted to the same ICU on an unscheduled basis within 72 hours of initial admission Denominator: Number of first-time intensive care events in 2007 for patients released alive
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QUALITY AND AFFICIENCY IN SWEDISH HEALTH CARE 2008