Since 2011, ICNARC has published the Annual Quality Report for the Case Mix Programme (CMP). The Annual Quality Report makes results from the CMP public to provide a valuable insight into the quality of NHS adult critical care both overall, and at the following levels: - Critical Care Network* - Trust or Health Board - Hospital - Individual critical care unit 100% of all adult critical care units in England, Wales and Northern Ireland now participate in the CMP. 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 Case Mix Programme (CMP) Annual Quality Report follows a clear publication process: - All participating NHS adult 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 both the Clinical Director of each participating unit, as well as from the Chief Executive of the Trust - 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 locked on **31 August 2016**. Data received and/or validated after this date are not included in this report.

Eligibility criteria for inclusion in the Annual Quality Report for NHS adult critical care units for 2015/16 are as follows: - Adult critical care units located in NHS hospitals in England, Wales and Northern Ireland participating in the Case Mix Programme (CMP) - Have submitted six months of data for the period 1 April to 31 March of the reporting year - Have fully completed data validation - Formal, signed consent from the Clinical Director of the critical care unit and the Chief Executive of the Trust 93% of critical care units that participate in the CMP are eligible for inclusion in the Annual Quality Report 2015/16. Critical care units that are not eligible, along with units that were not participating in the CMP on 31 March 2016, are listed by country below. ### England  ### Wales  ### Northern Ireland 

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: Network, 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. 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 *_Please note: NHS organisation structure correct for reporting period._

The Annual Quality Report currently reports on eight potential quality indicators. ICNARC has developed two new potential quality indicators for this Annual Quality Report. The potential quality indicators reported in the Annual Quality Report are as follows: ### High risk sepsis admissions - **Eligible:** Critical care unit admissions with sepsis (infection and two or more SIRS criteria during the first 24 hours following admission) from a ward, intermediate care or obstetric area in the same hospital - **Numerator:** Number of eligible admissions with four or more organ dysfunctions 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:** All critical care unit admissions - **Numerator:** Bed days of care provided for critical care unit survivors more than 8 hours after the reported time fully ready for discharge - **Denominator:** Number of available critical care bed days ### Non-clinical transfers (out) - **Eligible:** All critical care unit admissions - **Numerator:** Number of critical care unit survivors receiving Level 3 care (for HDUs, Level 2 care) on discharge and discharged for comparable critical care to a Level 3 bed (for HDUs, 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 admissions 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 admissions 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 - 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_ For further information on the Case Mix Programme or any other ICNARC activities visit out website [http://www.icnarc.org](http://www.icnarc.org)