InfoFlex

Irish National Intensive Care Unit (ICU) Audit System

DMF Systems, an established provider of software to the Irish healthcare sector, is the prime contractor with the Health Service Executive (HSE) for the Irish National Intensive Care Unit (ICU) Audit project. In collaboration with the National Office of Clinical Audit (NOCA) and the Intensive Care National Audit & Research Centre (ICNARC) in the UK, the project provides benchmarking for ICUs across Ireland and supports improvements in critical care.

Declan Fitzgerald, Founder of DMF Systems, saw InfoFlex as the ideal product for the opportunity that the Irish National ICU Audit presented and chose to partner with them. ICNARC were already benchmarking ICUs in the UK through their Case Mix Programme (CMP) and NOCA wanted to take advantage of this expertise. InfoFlex had the facility to collect and store the Irish National ICU Audit dataset, which includes the ICNARC dataset for Ireland. InfoFlex stores this dataset and contains the clinical diagnostic codes which make up the ICNARC Coding Method (ICM).

Since its inception in 2013, the ICU Clinical Audit System (ICUCAS), developed by DMF Systems, has been rolled out across public hospitals in Ireland, with 22 hospitals initially covered by 2019. The system has expanded to include 25 hospitals and 29 units by 2023, with plans to incorporate private hospitals in the future.

What the NOCA Intensive Care Unit Team is Saying:

“We are pleased with the completion of the ICUCAS upgrade within InfoFlex. The inclusion of these changes have fully aligned the INICUA Dataset with the UK dataset while also updating medical terminology and inclusion of new treatments. We welcome the speedy validation process, allowing timely quarterly and annual reporting. While there have been valuable enhancements to the solution, the user interface has remained similar resulting in a smooth transition for ICUCAS users. We continue to work as a team with DMF to support improvement in the quality of data to monitor the care for the sickest patients in the hospital.”

National ICU Audit Objectives:

Benchmark ICU Outcomes: ICUCAS enables Irish hospitals to benchmark outcomes with similar ICUs in the UK and Ireland, ensuring continuous improvement in critical care.

Drive Quality Improvements: Audit results help hospitals improve patient outcomes by identifying areas for improvement in care quality.

Measure ICU Activity: ICUCAS informs the configuration of critical care services by providing reliable activity data.

Support HIPE & Activity-Based Funding: The system provides data to inform Hospital Inpatient Enquiries (HIPE) and Activity-Based Funding (ABF).

Audit HCAI and Organ Donation: ICUCAS audits healthcare-associated infections and potential organ donors in participating hospitals.

InfoFlex provided the core software system for the collection of the dataset required by NOCA, in line with the objectives above.

The fact that the InfoFlex team was familiar with the ICNARC CMP dataset and coding from the outset has proved hugely beneficial to the project. This enabled NOCA and the HSE in Ireland to achieve the very specific objectives outlined above.

InfoFlex ICU Clinical Audit System (ICUCAS)

ICUCAS, built on the InfoFlex platform, collects, validates, and securely transfers ICU data to ICNARC. ICNARC then validates and benchmarks this data, allowing participating hospitals to measure the quality of care, ICU activity, organ donation potential, and health care-associated infections (HCAIs). ICUCAS combines both the ICNARC dataset and the NOCA dataset to drive continuous improvement in care for critically ill patients.

The 2021 upgrade of ICUCAS aligned the Irish National ICU dataset with ICNARC’s Case Mix Programme (CMP) in the UK, ensuring consistency in medical terminology and the inclusion of new treatments. Despite these enhancements, the user interface remains intuitive, ensuring a seamless transition for clinical staff. This upgrade also improved the data flow process, making the extraction and transfer of data via Platform-X to ICNARC faster and more efficient.

Integrated Data Solutions for Comprehensive ICU Benchmarking

Initially, NOCA and ICNARC collaborated to create the Irish National ICU Audit dataset. DMF Systems then partnered with InfoFlex to develop supporting software. This dataset includes key physiological variables for critical illness scoring and tracks organ support per patient per ICU day. Extracted data is reported by ICNARC, facilitating outcome benchmarking.

A crucial component of this project is InfoFlex’s seamless integration with hospital systems like the Patient Administration System (PAS) and, where applicable, Clinical Information Systems (CIS) in ICUs. These systems capture data directly from patient monitors and electronic records, which InfoFlex receives via live interface, validates through ICU Audit Coordinators, and then extracts for ICNARC’s validation and reporting. Significant development was invested in creating robust, automated interfaces to support accurate data flow.

DMF Systems is further advancing the system to include real-time unit occupancy displays, enhancing capacity management across hospitals. This future upgrade will enhance the system’s utility in optimizing ICU resource allocation across Ireland. Governance for the ICU audit project remains under NOCA’s oversight.