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ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
ICU Database : A Broad Introduction
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ICU Database : A Broad Introduction

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  • Patient data recorded in standard and consistent methodologyWeb based on an oracle platform with in inbuilt security measures to meet privacy requirementsSite specific data protection measures with close monitoring of data input and outputFlexible, with capability to add new data elements as neededData extraction capabilities to help generate variety of information and reporting
  • History and Current UsersDate Site1997/98 Joint development by SPH, VGH, Victoria ICU physicians1999 PHC: St. Paul’s Hospital2000 VCHA: Vancouver General Hospital2002 Richmond Hospital2005 Lion’s Gate Hospital2006 Mount St. Joseph2006 FRASER HEALTH: Royal Columbian, Surrey, Burnaby, Peace Arch2008 Powell River (1-year); Royal Columbian Hospital High Acuity UnitFebruary 2009 Abbotsford, Langley, Chilliwack, Ridge MeadowsAugust 2009 NORTHERN HEALTH: Prince George
  • The TeamInformatics Team, Health Authority Teams, a common advisory team, CCWG, MoH, BSPQSC, CCVSM
  • All provincial data in one database, although separated by security barriers, means no need for efforts to further integrate or worry about consistency
  • All provincial data in one database, although separated by security barriers, means no need for efforts to further integrate or worry about consistency
  • Transcript

    • 1. ICU Database : A Broad IntroductionCritical Care Quality DayJune 4, 2013Sharmin GaniCritical Care Regional Advisor, VCH-PHC
    • 2. The provincial ICU database is the data repositoryof critically ill patients who have received care atany participating site in the provinceWhat is the BC ICU Database2• Standard and consistent data collection methodology• Web based oracle platform• Site and user specific privacy protection measures• Data extraction capabilities to help generate variety ofinformation and reporting
    • 3. BC Health Regions: 30 Health Care Sites with Critical Care FacilitiesHospital with ICU3
    • 4. HealthAuthorityTertiary(2 Sites)Regional Tertiary(9 Sites)IntermediateLevel I(1 Site)IntermediateLevel II(7 Sites)CommunityLevel I(4 Sites)CommunityLevel II(7 Sites)Northern(1 site)• University Hospitalof Northern BC(UHNBC)Interior(8 sites)• Kelowna General(KGH)• Royal Inland (RIH)• Penticton (PEN)• Vernon Jubilee(VJH)• KootenayBoundary (KBR)• East Kootenay(EKH)• CaribooMemorial (3 beds)• Shuswap Lake (3beds)VancouverIsland(6 sites)• Nanaimo Regional• Royal Jubilee(RJH)• Victoria General(VIC)• Campbell River &District• St. Josephs• CowichanVancouverCoastal &Providence(7 sites)• St. Paul’s (SPH)• VancouverGeneral (VGH)• Lion’s GateHospital (LGH)• Mount St. Joseph’s(MSJ)• Richmond (RH)• Powell RiverGeneral• St. Mary’sFraser(8 sites)• Surrey Memorial(SMH)• Royal Columbian(RCH)• AbbotsfordRegional (ARH)• Burnaby General(BGH)• Langley Memorial(LMH)• Peace Arch (PAH)• Ridge Meadows(RMH)• Chilliwack General(CGH)BC Health Care Sites with Critical Care Facilities4  Active in ICU database
    • 5. Jointly developedby St. Paul’s,Vancouver andVictoria ICUphysiciansPHC VCHFHA&VIHAIHAICU Database: Timeline of Development & GrowthNHAOngoingHaltedDataCollectionStatus161541235678910111213145
    • 6. VCH PHC FH NH IH VIHAMinistry ofHealthCriticalCareWorkingGroup3 sites 2 Sites 8 Sites 1 Site(Advisory, initiation & tech support to all Health Authorities)2 Sites(Informatics staff at each participating site)ICU Database AdministrationAt VCH-PHCBCPSQC PTN OtherProvincial ICU Database: Organizational Layout6
    • 7. InformaticsPatientcomes tohospitalPatientreceivescritical carePatientleaveshospitalINPatient isadmitted toICUPatientdischargedfrom ICUICU DatabaseOUTAnalyticsReports fromextracted DataICU Database: Information FlowCare of Critically Ill Patients7
    • 8. ICU Database: Data Content & UseOperationsMeasurement1Quality &SafetyIndicators2ClinicalResearch3Basic data collectionof minimum datasetEnhanced datacollectionTargeted dataextractiondepending onresearch criteria8• More than 30 data collection screens for data input• More than 45 data extracts for data output
    • 9. DemographicsAdmission &DischargeSeverity ofIllnessDiagnoses Name Age PHN/MRN City, Province Insurer Date & Time Location Service Disposition Overflow Primary Other Admit Chronic Acquired MechanicalVentilation Dialysis Arterial andCentral Lines Others Apache IIscores Apache IVscores SOFA Level of CareAssessmentsProceduresEven the minimum dataset can be used to produce powerful reportson operations and performanceICU Database: Basic Data Collection9
    • 10. VCH-PHC Case Volume by Site, Fiscal Year & Quarter10FY2009/10FY2010/11FY2011/12Q1 2009 Q2 Q3 Q4 2009/10 Q1 2010 Q2 Q3 Q4 2010/11 Q1 2011 Q2 Q3 Q4 2011/12VGH 284 306 307 299 1,196 327 338 353 323 1,341 344 349 298 330 1,321SPH 147 171 162 168 648 154 165 148 171 638 169 175 171 175 690MSJ 41 55 41 40 177 49 46 60 49 204 48 42 46 48 184LGH 94 94 96 92 376 90 110 106 84 390 87 87 78 91 343RH 135 123 89 102 449 110 100 110 136 456 97 115 120 104 436(50)1503505507509501,1501,350TotalAdmissions
    • 11. VCH-PHC Average Length of Stay (ALOS) Days11
    • 12. VCH-PHC Admit & Discharge Levels of Care12
    • 13. 13FY2009/10FY2010/11FY2011/12Q1 2009 Q2 Q3 Q4 2009/10 Q1 2010 Q2 Q3 Q4 2010/11 Q1 2011 Q2 Q3 Q4 2011/12VGH 89% 89% 91% 87% 89% 83% 89% 83% 85% 85% 89% 88% 87% 89% 88%SPH 73% 73% 69% 77% 73% 68% 64% 72% 71% 69% 69% 66% 71% 62% 67%MSJ 20% 38% 29% 38% 32% 31% 24% 28% 20% 26% 29% 26% 35% 35% 32%LGH 74% 81% 81% 75% 78% 74% 78% 72% 85% 77% 78% 79% 90% 82% 82%RH 44% 42% 54% 43% 45% 52% 57% 43% 45% 49% 50% 38% 53% 43% 46%0%10%20%30%40%50%60%70%80%90%100%VCH-PHC Percentage of Vented Cases
    • 14. Safety & QualityClostridiumDifficileGlycemic IndicesVentilator AcquiredPneumonia(Suspected)Major Bleeds(on Anticoagulants)Central Venous Catheter Related BloodStream InfectionsVasoactive DrugsBlood ProductsVent AuditsMobility ScoresSedation (RASS)& Delirium ScoresTrauma Scores(TRISS)ICU Database: Enhanced Data Collection• Enhanced data collection can help produce safety and qualityindicators for continuous improvementGlycemic Indices• BC MoH has adopted the Glycemic Indices as quality indicators to betracked at critical care sites 14
    • 15. ICU Database Variation in length of ICU stay after cardiac arrest: where you are is as important as who you are. Critical CareMedicine. 2007; 35: 836-841. Pneumothorax After Insertion of Central Venous Catheters in the Intensive Care Unit: Association with Month of Yearand Week of Month. Quality and Safety in Health Care, 2007 16: 252-255 Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent. Chest.2008; 134: 1217-1222. Reliability of ICU Admitting and Comorbid Diagnoses, Race, Elements of APACHE II Score, and Predicted Probabilityof Mortality in an Electronic ICU Database. Journal of Critical Care. 2009; 24: 401-407. Introduction of a comprehensive management protocol for severe sepsis is associated with sustained improvementsin timeliness of care and survival. Quality and Safety in Health Care. 2010; 19: 1-7. Nursing Work Schedules and the Risk of Hypoglycemia in Critically Ill Patients Receiving Intravenous Insulin. Qualityand Safety in Health Care 2010; 19: 1 Association of angiotensin II type 1 receptor-associated protein gene polymorphism with increased mortality in septicshock. Critical Care Medicine. 2011 Jul;39(7):1641-8. Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury.Critical Care 2012, 16:R128; 1-7 Normal-range blood lactate concentration in septic shock is prognostic and predictive. Shock. 2012 Jul;38(1):4-10.ICU Data for Research Projects15
    • 16. Question: How much data do we have in the ICU database?Answer: Almost 70,000 cases and more than 20M data pointsSite Cases DataVancouver General 15,656 5,422,340St. Pauls 10,122 3,842,014Richmond 6,426 1,455,584Mount St. Joseph 3,900 525,865Lions Gate 2,881 1,057,420Total 38,985 12,303,223Site Cases DataKootenay Boundary 599 130,177Royal Inland 374 154,519Kelowna General 164 22,385Total 1,137 307,081Site Cases DataPrince George 2,574 647,205Total 2,574 647,205Site Cases DataRoyal Columbian 9,173 2,414,604Surrey Memorial 3,814 1,326,155Burnaby General 3,196 818,652Chilliwack General 2,786 488,960Ridge Meadows 2,502 499,871Langley Memorial 1,956 399,987Abbottsford Regional 1,863 591,603Peach Arch 1,812 354,398Total 27,102 6,894,230ICU Database: A Current State AssessmentInteriorVancouver Coastal- ProvidenceFraserNorthernOur greatest strength lies in the big volume of highquality data 16
    • 17.  What information from the database do we need toimprove patient care? Which important research questions do we think we couldaddress using the database? What things would we like to do for quality improvement?ICU Database: Looking Towards FutureImmediateFocusLong TermVisionGetting better and more timely information fromour existing data How do we link our data to other relevant data systems togain enhanced insights towards better care? How can move to a real time information system? How do we leverage technological advances in this era ofBig Data?Creating an information system that enablessmarter delivery of care for our critically ill patients17
    • 18. To share photographer Rick Smolan’s vision of Big Data on THNKR , pleasego to http://www.youtube.com/watch?v=fc1zBNC9wNY&sns=em“Big Data is the next frontier for innovation, competition,and productivity”– McKinsey & Company18ICU Database: Looking Towards Future
    • 19. Thank You19

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