The Assessment of Risk for Cardiothoracic Intensive Care (ARCtIC) is a national clinical audit of patient outcomes for those admitted to a cardiothoracic critical care unit in the UK. Cardiothoracic critical care units participate in ARCtIC by submitting data to ICNARC via the Case Mix Programme (CMP) platform. The Annual Quality Report (AQR) 2017/18 for adult cardiothoracic critical care makes results from ARCtIC public to provide a valuable insight into the quality of NHS adult cardiothoracic critical care at the following levels: - Trust or Health Board* - Hospital - Individual adult cardiothoracic critical care unit The number of adult cardiothoracic units participating in ARCtIC is steadily increasing over time. Following rigorous data validation, all participating units receive regular, quarterly comparative reports for local performance management and quality improvement. _*NHS organisation structure correct for reporting period_

The Annual Quality Report for adult cardiothoracic critical care follows a clear publication process: - All participating NHS adult cardiothoracic critical care units who have collected and submitted data from the period 1 April to 31 March of the reporting year are identified; - These units have been asked to agree to public disclosure of their results and have been given the option to consent (or not) to this disclosure; - To obtain consent, ICNARC has requested signatures from the Clinical Director of each participating unit and the Chief Executive of the Trust; and - If analysis reveals a participating unit as a potential outlier, ICNARC follows a clear 'Detection and management of outliers' policy (see Appendix: _Managing outliers_). For the purposes of analysis, the database was locked on **10 September 2018**. Data received and/or validated after this date are not included in this report.

At the time of publication, 20 NHS adult cardiothoracic critical care units are participating in ARCtIC. Eligibility criteria for inclusion in the Annual Quality Report 2017/18 for adult cardiothoracic critical care are as follows: - Adult cardiothoracic critical care units located in UK NHS hospitals participating in ARCtIC; - Have submitted and completed validation for six months of data for the period 1 April to 31 March of the reporting year; and - Formal, signed consent from the Clinical Director of the critical care unit and the Chief Executive of the Trust. The following 14 adult cardiothoracic critical care units meet these eligibility criteria and are included in the 2017/18 report: - Bristol Heart Institute - Cardiac Intensive Care unit; - Castle Hill Hospital - GICU1; - Essex Cardiothoracic Centre - Colne Ward ITU; - Freeman Hospital - Ward 21 Cardiothoracic Intensive Therapy Unit; - Glenfield Hospital - Adult Intensive Care Unit; - Harefield Hospital - Intensive Care Unit; - Liverpool Heart and Chest Hospital – Intensive Therapy Unit; - Manchester Royal Infirmary – Cardiac Intensive Care Unit; - Royal Brompton Hospital - Adult Intensive Care Unit; - Papworth Hospital – Critical Care Unit; - St Bartholomew’s Hospital – Cardiothoracic Intensive Care/High Dependency Unit; - St George’s Hospital – Cardiothoracic Critical Care Unit; - St Thomas’ Hospital – Overnight Intensive Recovery and Doulton High Dependency Unit; and - The James Cook University Hospital – Cardiac Intensive Care Unit. Further cardiothoracic critical care units which participate in ARCtIC through the CMP but are not eligible are listed below. Not enough data (less than six months in the reporting period): - Blackpool Victoria Hospital - Cardiac Intensive Therapy Unit; - John Radcliffe Hospital - Cardiac and Thoracic Critical Care Unit; - Northern General Hospital – Cardiac Critical Care Unit; and - Wythenshawe Hospital - Cardiothoracic Intensive Care/High Dependency Unit Joined ARCtIC from 1 April 2018 onwards: - Leeds General Infirmary - L04 - Cardiac Intensive Care Unit; and - University Hospital Coventry - Cardiothoracic Critical Care Unit.

To search for a required unit/site and results, use the toolbar and search facility at the top of each page. Search for your unit or site via: Trust (or Health Board), Hospital or Unit.* Once you have selected a site (including ‘all’), you can view results for each potential quality and participation indicator as follows: - Click through each results tab; - View results graphically (see Appendix: _Presentation of results_ for more information about the graphs used in this report); and - View the denominators behind the graphs, as well as definitions for each potential quality indicator in the accompanying text under each graph. *_Please note: NHS organisation structure correct for reporting period._

The Annual Quality Report currently reports on eleven potential quality indicators. The potential quality indicators reported in the Annual Quality Report are as follows: ### High-risk admissions from the ward - **Eligible:** Critical care unit admissions from a ward (or intermediate care or obstetric area) in the same hospital - **Numerator:** Number of eligible admissions with four or more organ dysfunctions (SOFA ≥ 2 per organ) during the first 24 hours following admission - **Denominator:** Number of eligible admissions ### High-risk sepsis admissions from the ward - **Eligible:** Critical care unit admissions with infection from a ward (or intermediate care or obstetric area) in the same hospital - **Numerator:** Number of eligible admissions with four or more organ dysfunctions (SOFA ≥ 2 per organ) during the first 24 hours following admission - **Denominator:** Number of eligible admissions ### Unit-acquired infections in blood - **Eligible:** Critical care unit admissions staying at least 48 hours - **Numerator:** Number of unit-acquired infections in blood, defined as the presence of infection in any blood sample taken for microbiological culture after 48 hours following admission - **Denominator:** Total number of patient days that eligible admissions stayed in the critical care unit ### Out-of-hours discharges to the ward (not delayed) - **Eligible:** Critical care unit survivors discharged to a ward in the same hospital - **Numerator:** Number of eligible admissions discharged between 22:00 and 06:59 and not delayed (i.e. not declared fully ready for discharge by 18:00 on that day) - **Denominator:** Number of eligible admissions ### Bed days of care post 8-hour delay - **Eligible:** Critical care unit survivors discharged to a ward in the same hospital (or direct to home) - **Numerator:** Bed days of care provided for critical care unit survivors more than 8 hours after the reported time fully ready for discharge - **Denominator:** Total number of available bed days in the critical care unit ### Bed days of care post 24-hour delay - **Eligible:** Critical care unit survivors discharged to a ward in the same hospital (or direct to home) - **Numerator:** Bed days of care provided for critical care unit survivors more than 24 hours after the reported time fully ready for discharge - **Denominator:** Total number of available bed days in the critical care unit ### Discharges direct to home - **Eligible:** Critical care unit survivors with a reason for discharge from the critical care unit of ending critical care, excluding planned admissions direct from home - **Numerator:** Number of eligible admissions discharged direct to a non-hospital location - **Denominator:** Number of eligible admissions ### Non-clinical transfers (out) - **Eligible:** All critical care unit admissions - **Numerator:** Number of critical care unit survivors receiving Level 3 care on discharge and discharged for comparable critical care to a Level 3 bed in a critical care unit in another acute hospital [For HDUs, number of critical care unit survivors receiving Level 2 care on discharge and discharged for comparable critical care to a Level 2 bed in a critical care unit in another acute hospital] - **Denominator:** Number of eligible admissions ### Unplanned readmissions within 48 hours - **Eligible:** Critical care unit survivors discharged to a ward within the same hospital - **Numerator:** Number of eligible admissions subsequently readmitted (unplanned) to the same critical care unit within 48 hours of discharge - **Denominator:** Number of eligible admissions ### Risk-adjusted acute hospital mortality - **Eligible:** All critical care unit admissions, excluding readmissions, patients dead on admission and those admitted to facilitate organ donation - **Numerator:** Observed number of eligible admissions that died before ultimate discharge from acute hospital - **Denominator:** Expected number of acute hospital deaths among eligible admissions from the ICNARC~_H_-2015~ model ### Risk-adjusted mortality – predicted risk < 20% - **Eligible:** All critical care unit admissions with a predicted risk of death < 20% on the ICNARC~_H_-2015~ model, excluding readmissions, patients dead on admission and those admitted to facilitate organ donation - **Numerator:** Observed number of eligible admissions that died before ultimate discharge from acute hospital - **Denominator:** Expected number of acute hospital deaths among eligible admissions from the ICNARC~_H_-2015~ model Other results included in the Annual Quality Report: ### Active participation - Available data are based on eligible (see Introduction: _Participation and coverage_) units with data for each quarter – reported as the percentage of all participating unit(s) within the selection ### Data completeness - Data completeness is based on all admissions to participating unit(s) within the selection - Indicates the level of completeness of data in all fields used to calculate each potential quality indicator Potential quality indicators are presented: - together on a single 'dashboard' with appropriate comparator and threshold values indicated; and - individually on a funnel plot. See Appendix: _Presentation of results_ for more information.

For questions or feedback on or about this Annual Quality Report, please contact ICNARC via email: [arctic@icnarc.org](mailto:arctic@icnarc.org) For further information on ARCtIC, the Case Mix Programme or any other ICNARC activities visit our website [http://www.icnarc.org](http://www.icnarc.org)