20 - Audit in intensive care

Summary

This review will examine audit in intensive care (systems of quality assurance), and audit of intensive care (what intensive care has achieved). An approach to intensive care audit, and the framework of the review, is given in Figure 20.1. It may be helpful to start by defining the main terms used in this chapter.

Key definitions

Intensive care is a multi-disciplinary specialty providing a comprehensive diagnostic and therapeutic service for patients with acute failure of two or more organ-systems, or with isolated acute respiratory failure. Patients with single organ-system failures may also require intensive care if their condition is unstable. A minimum 1:1 nurse:patient ratio is required, in intensive care units (ICUs) together with continuous cover by consultants and resident junior doctors.

High dependency units (HDUs) are intended to care for patients with acute failure of not more than one organ-system, excluding acute failure of the respiratory system. HDUs are not suitable places for caring for patients requiring mechanical ventilation or complex organ-system support. They have an important prophylactic role in preventing organ-system dysfunction and in treating postoperative pain following major surgery. Specialist HDUs such as coronary care, renal medicine and transplant units are often best sited within the relevant specialist clinical area, but general service HDUs (for hospital-wide work) should be placed close to the ICU in order to ensure fair access to all clinical services, and to make efficient use of existing medical management and nursing expertise.