Assessing and combining repeated prognosis of physicians and temporal models in the intensive care.

Objective: Recently, we devised a method to develop prognostic models incorporating patterns of sequential organ failure to predict the eventual hospital mortality at each day of intensive care unit (ICU) stay. In this study, we investigate using a real world setting how these models perform compared to physicians, who are exposed to additional information than the models.

Methods: We developed prognostic models for days 2-7 of ICU stay by data-driven discovery of patterns of sequential qualitative organ failure (SOFA) scores and embedding the patterns as binary variables in three types of logistic regression models.

Consistency of nurses' daily predictions of survival in the intensive care.

In the Intensive Care Unit, clinicians are continuously faced with the difficult task of prognosis, but their predictions of patient survival status may not always be consistent. Specifically very little is known about consistency of predictions over time. The aim of this paper is to assess the consistency of nurses' daily predictions of survival in terms of inter-observer variance and variance of observers over time.

Statistical process control for monitoring standardized mortality ratios of a classification tree model.

Objectives: The ratio of observed to expected mortality (standardized mortality ratio, SMR), is a key indicator of quality of care. We use PreControl Charts to investigate SMR behavior over time of an existing tree-model for predicting mortality in intensive care units (ICUs) and its implications for hospital ranking. We compare the results to those of a logistic regression model.

Five years of therapeutic drug monitoring in the intensive care did not change vancomycin prescription behaviour: perceived needs for decision support.

Background: This study aims to assess clinicians' behaviour in prescribing vancomycin in the Intensive Care Unit (ICU) and their adherence to local guidelines for therapeutic drug monitoring (TDM).

Methods: In this observational cohort study we included all consecutive patients admitted to a 28-bed multidisciplinary mixed adult ICU of a large university hospital in Amsterdam between January 2002 and September 2007 who were prescribed vancomycin for ≥ 3 days. We measured guideline adherence by checking for each given advice the corresponding action and monitored adherence over time using Statistical Process Control.

Effect of changes over time in the performance of a customized SAPS-II model on the quality of care assessment.

Purpose: The aim of our study was to explore, using an innovative method, the effect of temporal changes in the mortality prediction performance of an existing model on the quality of care assessment. The prognostic model (rSAPS-II) was a recalibrated Simplified Acute Physiology Score-II model developed for very elderly Intensive Care Unit (ICU) patients.

Methods: The study population comprised all 12,143 consecutive patients aged 80 years and older admitted between January 2004 and July 2009 to one of the ICUs of 21 Dutch hospitals.