Developing quality measures for sepsis care in the ICU

Background: Sepsis is associated with increased morbidity, mortality, and costs of care. Although several therapies improve outcomes in patients with sepsis, rigorously developed measures to evaluate quality of sepsis care in the intensive care unit (ICU) are lacking. Methods: To select an initial set of candidate measures, in 2003-2004 an interdisciplinary panel reviewed the literature and used a modified nominal group technique to identify interventions that improve outcomes of patients with sepsis in the ICU. Design specifications or explicit definitions for each candidate measure were developed. Results: Ten potential measures were identified: vancomycin administration, time to vancomycin initiation, broad-spectrum antibiotic administration, time to broad-spectrum antibiotic initiation, blood culture collection, steroid administration, corticotropin stimulation test administration, activated protein C eligibility assessment, activated protein C administration, and vancomycin discontinuation. Discussion: The identification of potential measures of quality of care for patients with sepsis can help caregivers to focus on evidence-based interventions that improve mortality and to evaluate their current performance. Further work is needed to evaluate the feasibility and validity of the measures.