Intensive Care Unit clinical outcomes

Clinical outcomes are broadly agreed, measurable changes in health or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.

About the Intensive Care Units

Our Paediatric and Neonatal Intensive Care Unit (PICU/NICU) and Cardiac Intensive Care Unit (CICU) provide medical treatment to children who are critically ill. The intensive care unit teams provide a tertiary referral service both nationally and internationally. Our specialist multidisciplinary service is one of the largest for children in the United Kingdom and Europe.

Clinical outcome measures

PIM2r Adjusted Funnel Plot showing Mortality Rates for Paediatric Intensive Care

The primary outcome measure used in Intensive Care Units (ICU) is the survival rate for patients, measured at the time when they are discharged. Raw survival/mortality rates may be challenging to interpret as patients that are admitted in a sicker condition are at greater risk, and therefore the outcomes need to be ‘adjusted’ to consider the level of severity of the patients in respect of case mix.

The PIM2r (Paediatric Index of Mortality version 2r) score is calculated for every child admitted to ICU and assesses severity of illness and risk of death on admission and is based on medical history, interventions and physiological measurements taken from time of first contact with an ICU doctor up to the first hour after admission. The standardised mortality ratio (SMR) is the ratio of the percentage of actual deaths compared to the percentage of expected deaths based on the PIM2r score: this is a method of benchmarking the outcomes between ICUs nationally.

The Tables and the Funnel plots shown were provided by the Pediatric Intensive Care Audit Network body (PICANet) for admissions to the GOSH ICUs between 2010 and 2012, and between 2013 and 2015.

Centre E1 is GOSH Paediatric and Neonatal ICUs (PICU/NICU) and Centre E2 is GOSH Cardiac ICU (CICU). The adjusted SMR indicates that the mortality rate, after adjustment for case mix, is slightly lower in CICU than the national average, and slightly higher than the national average in PICU / NICU. The outcomes for both units fall within the selected confidence limits and therefore E1 and E2 could be described as having case mix adjusted mortality rates that fall within the expected range.

Table 1.1 Standardised Mortality Ratio (SMR) for PICU/NICU and CICU for 2013-2015

2013-2015

Number of Admissions STANDARDISED MORTALITY RATIO
Unadjusted (95% CI) PIMr2 Adjusted (95% CI)
Organisation SMR Lower Upper SMR Lower Upper
E1 2,950 1.58 1.36 1.83 1.12 0.97 1.3
E2 2,465 0.77 0.6 0.97 0.89 0.69 1.11

Figure 1.1 Standardised Mortality Ratio (SMR) funnel plot for PICU/NICU and CICU, 2013-2015

Figure 1.2 Standardised Mortality Ratio (SMR) funnel plot for PICU/NICU and CICU, 2013-2015

This information was published in January 2017, and will be updated annually.