Irish National Intensive Care Unit (ICU) Audit System

DMF Systems is an established provider of software to the Irish healthcare sector and is the prime contractor with the HSE (Health Service Executive in the Republic of Ireland) for the national ICU audit project. The National Office of Clinical Audit (NOCA), is working with the HSE to deliver the Irish National ICU Audit to 22 Irish hospitals. The HSE provide the funding while NOCA define the scope of work. NOCA operationally manages the audit in collaboration with the Intensive Care National Audit & Research Centre (ICNARC) in the UK.

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).

Issues addressed

National ICU Audit Objectives:

• Measure quality of care in ICUs by benchmarking outcomes.
• Use audit to drive improvements in quality of care.
• Measure activity to inform configuration of Critical Care.
• Provide data to support HIPE (Hospital Inpatient Enquiries) and ABF (Activity Based Funding).
• Audit HCAI (Health Care Associated Infection).
• Audit of potential organ donors and organ donation.

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.

Firstly, NOCA and ICNARC worked together to create an Irish National ICU Audit dataset. DMF Systems then worked with InfoFlex to design the software to support this dataset. Included within this data are physiological variables to support critical illness scoring and details of organs supported per patient per day of stay in ICU. The extracted data is reported on by ICNARC, enabling the benchmarking of outcomes.

To support the objectives of this project, the availability of interfacing with existing hospital systems with InfoFlex was very important. These systems include the Patient Administration System (PAS) and, where applicable, the Clinical Information Systems (CIS) within the ICU departments. These clinical systems take information from monitors attached to the patient, as well as other clinical information charted electronically at the point of care. The data is then delivered to InfoFlex via a live interface and validated by the ICU Audit Coordinators. It is then extracted for submission to ICNARC for further validation and reporting. A significant amount of development was required to create robust interfaces which automatically passed on the relevant information to InfoFlex. The project is currently on schedule to be rolled out to all 22 hospitals by 2019.

For the future, DMF Systems is also adapting the system to allow these interfaced data to feed a system that will display the occupancy in each unit. This will result in a facility which can manage patient capacity across hospitals and ICUs. Governance for this project is provided by NOCA.