Description of trends in the course of illness of critically ill patients. Markers of intensive care organization and performance

Objective: To identify objective trends of the course of illness that might be used as benchmarks in the auditing of the organization/performance of Intensive Care Units (ICU). Design: Retrospective analysis. Patients and setting: A group of 12,615 patients and 55,464 patient-days prospectively collected in 89 ICUs of 12 European countries. Methods: The complexity of daily care in the ICU was classified as high (HT) or low (I-T), according to six activities registered in NEMS, a daily therapeutic index for ICUs. Results: Six trends of clinical course were identified: LT during the whole ICU stay (5,424 patients, mortality 1.8%); HT (3,480 patients, mortality 30.4%); HT followed by LT (2,781 patients, mortality 2.8%); LT followed by HT (197 patients, mortality 39.1%); finally, LT/HT/LT in 298 patients (mortality 10.5%); and HT/LT/HT (mortality 20.1%) in 438 patients. A group of 930 patients had the complexity of treatment increased (mortality 21.1%) and 3,711 patients received both treatments. Low-care before high-care periods had a mean duration of 2.2+/-3.5 days, low-care after high-care 2.7+/-3.1 days, and between two high-care periods 2.1+/-2.2 days. A group of 1,538 'surgical scheduled' patients only received LT, whereas 2,231 received HT (whether or not exclusively). Overall ICU mortality rate was low (3%) and the length of stay short, regardless of diagnosis and complexity of care received. Conclusions: The use of therapeutic indexes help to classify the daily complexity of ICU care. The classification can be used as an indicator of clinical performance and resource utilization.