In 1994, ICNARC established the national clinical audit for adult critical care; the Case Mix Programme (CMP). Over 95% of all adult, general critical care units in England, Wales and Northern Ireland now participate as well as an increasing number of specialist critical care services. Following rigorous data validation, all participating units receive regular, quarterly comparative reports for local performance management and quality improvement.

Since 2011, ICNARC has published the Annual Quality Report for general critical care. In 2013, following overwhelming support from participating specialist units, ICNARC have extended the remit of public reporting to all specialist, NHS participating CMP critical care units.

This report makes results from the CMP public with the aim of providing a valuable insight into the quality of NHS adult, neurocritical (neuro or combined ICU/neuro) unit (neuro or combined ICU/neuro) care.

The Case Mix Programme (CMP) Annual Quality Report follows a clear publication process:

1. All participating NHS adult, neurocritical (neuro or combined ICU/neuro) care units  who have collected and submitted data from the period 1 April to 31 March of the reporting year are identified
2. 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
3. To obtain consent, ICNARC has requested signatures from both the Clinical Director of each participating unit, as well as from the Chief Executive of the Trust
4. If analysis reveals a participating unit with 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 originally locked in July 2013. This report has been updated using additional data recieved after this date, up until 10 April 2014. Data received and/or validated after this date are not included.

Eligibility criteria for inclusion in the Annual Quality Report for NHS adult, neurocritical (neuro or combined ICU/neuro) care units  are as follows:

• Adult, neurocritical care units located in NHS hospitals in England, Wales and Northern Ireland participating in the Case Mix Programme (CMP)
• Have submitted at least six months of data for the period 1 April to 31 March of the reporting year
• Have fully completed the first cycle of data validation through a first Data Validation Report
  (all data are updated six months after original publication, with fully validated data, where applicable)
• Formal, signed consent from the Clinical Director of the adult, neurocritical care unit and the Chief Executive of the Trust

Results for all eligible sites can be found using various ways. See guidance and examples below to find out how to search for a required site and results.

Search for your unit or site via:

Please note: NHS organisation structure correct for reporting period

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. For more information about the graphs used in this report, see appendix: Presentation of results
• View the denominators behind the graphs, as well as definitions for each potential quality indicator in the accompanying text under each graph

The Annual Quality Report currently reports on seven potential quality indicators.

Some potential quality indicators are prescribed by the Clinical Reference Group for adult critical care in relation to specialised commissioning (see Appendix: Clinical Reference Group (CRG)).

Potential quality indicators marked with an asterix (*) indicate those defined by the Clinical Reference Group for adult critical care.

The potential quality indicators reported in the Annual Quality Report are as follows:

Hospital mortality

• Hospital mortality is defined as death before ultimate discharge from acute hospital
• A mortality ratio is calculated by dividing the observed by the expected acute hospital mortality, with the expected estimated by a risk prediction model, a mortality ratio is one (1.0) when the observed and expected acute hospital mortality are equal
• The ICNARC model was developed and validated using Case Mix Programme (CMP) data and is regularly recalibrated to ensure accuracy. The model describes the relationship between case mix factors (from the first 24 hours following admission to an NHS adult, neurocritical (neuro or combined ICU/neuro) care unit) and hospital mortality
• The ICNARC model estimates the expected number of acute hospital deaths for a given adult, neurocritical care unit based on the case mix of its admissions

Please note: ICNARC have recently recalibrated the ICNARC model specifically to data from NHS adult, neurocritical care units to improve the fit of the model to the case mix of patients admitted to this unit type

Unit-acquired Methicillin-resistant Staphylococcus aureus (MRSA)

• Presence of MRSA in any sample taken for microbiological examination after 48 hours following admission to the adult, neurocritical care unit – reported as the rate per 1000 patient days among all patients staying at least 48 hours and excluding those with admission MRSA or no samples taken
• The comparator value is the overall rate of unit-acquired MRSA from all NHS adult, neurocritical care units in the CMP for the time period of the report

Non-clinical transfers (out)*

• Neurocritical care unit survivors discharged for comparable critical care to a Level 3 bed in an adult ICU or ICU/HDU in another acute hospital – reported as the percentage of all neurocritical care unit admissions
• The comparator value is the overall percentage of non-clinical transfers (out) from all NHS adult, neurocritical care units in the CMP for the time period of the report

Out-of-hours discharges to the ward*

• Neurocritical care unit survivors discharged to a ward in the same hospital between 22:00 and 06:59 – reported as the percentage of all neurocritical care unit survivors discharged to a ward in the same hospital
• The comparator value is the overall percentage of out-of-hours discharges to the ward in all NHS adult, neurocritical care units in the CMP for the time period of the report

Out-of-hours discharges to the ward (not delayed)

• Neurocritical care unit survivors discharged to a ward in the same hospital out-of-hours (between 22:00 and 06:59) who are not delayed i.e. not declared fully ready for discharge by 18:00 on that day – reported as the percentage of all neurocritical care unit survivors discharged to a ward in the same hospital
• The comparator value is the overall percentage of out-of-hours discharges to the ward (not delayed) in all NHS adult, neurocritical care units in the CMP for the time period of the report

Delayed discharges (4 hour delay)*

• Neurocritical care unit survivors with a delay of 4 hours or more between time when fully ready for discharge and time of discharge, excluding those where discharge within 4 hours would have resulted in discharge between 22:00 and 06:59 – reported as the percentage of all neurocritical care unit survivors
• The comparator value is the overall percentage of delayed discharges (4 hour delay) in all NHS adult, neurocritical care units in the CMP for the time period of the report

Unplanned readmissions within 48 hours*

• Neurocritical care unit survivors discharged to a ward in the same hospital that are subsequently readmitted to the same adult, neurocritical care unit within 48 hours of discharge and the subsequent admission is classified as unplanned – reported as the percentage of all neurocritical care unit survivors discharged to a ward within the same hospital
• The comparator value is the overall percentage of unplanned readmissions within 48 hours in all NHS adult, neurocritical care units in the CMP for the time period of the report

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 units within the selection

 
Data completeness

• Data completeness is based on all admissions to 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
• 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: cmp@icnarc.org