Small steps beyond benchmarking - Critical Care Science (CCS)

Examples of actionable indicators

A typical example of an “actionable indicator” could be the use of antibiotics on the ICU. Unnecessary long-term use of broad-spectrum antibiotics is linked to the emergence and selection of resistant bacteria, prolonged hospitalization and increased costs. Reduction of the median antibiotic duration on the ICU to 5 days is feasible.⁽⁾ Such a reduction of antibiotic duration can be achieved by implementing a biomarker guided stopping of antibiotics or by a step wise reduction of antibiotic duration in comparison with peers (the benchmark). If your current practice or protocol demands 10 days of antibiotics for severe community-acquired pneumonia and the evidence advocates 5 – 7 days then the next step is to decrease the duration of antibiotics to 7 days and check your outcomes. Examples of potential improvements mentioned in the toolbox are either updating or creating of a protocol, alerts in your electronic patient records or computerized physician ordering entry whenever a prescription of more than 7 days is ordered. If mortality, days on the ventilator, and length of stay on the ICU are unchanged then a further reduction of antibiotic duration (to 5 days) can be achieved. Meanwhile, the ICU will learn that shorter courses of antibiotics are not to be feared.

Another example of an “actionable indicator” is the use of blood products.⁽⁾ Many physicians feel uneasy when haemoglobin counts drop and want to transfuse such patients. Publications show similar outcomes with a more restrictive transfusion policy versus a more liberal transfusion policy.^(,) Comparing the median transfusion need in your ICU to that of the general benchmark might identify patients in which your ICU might implement a more restrictive transfusion policy without compromising outcome.⁽⁾

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