TABLE 2 ] .
Examples of Process Metrics for Value
| Metric | Description |
| Global | |
| ICU nurse staffing12,60 | Average nurse:patient ratio |
| Daily rounds by an intensivist44 | Percentage of daily rounds led by an intensivist |
| Rounds including pharmacist45 | Percentage of daily rounds with clinical pharmacist present |
| Daily goals/safety checklist46 | Percentage of patient days with a completed daily goals checklist |
| Neurologic | |
| Effective pain assessment32, a | Percentage of patient days during which pain was evaluated four or more times per shift |
| Effective sedation assessment32, b | Percentage of patient days during which sedation was evaluated four or more times per shift |
| Effective delirium assessment32 | Percentage of patient days with delirium assessed using formal tool |
| Sleep promotion47 | Percentage of patient days with adherence to sleep promotion checklist |
| ICU mobilization48 | Percentage of patient days receiving mobility therapy |
| Pulmonary | |
| Head-of-bed elevation26 | Percentage of patient days where the head of bed is elevated ≥ 30° |
| Daily chlorhexidine oral care49 | Percentage of patient days where patients had oral care with chlorhexidine |
| Lung protective ventilation14,50 | Percentage of ventilator days on which patients with ARDS receive a tidal volume < 6.5 mL/kg predicted body weight and plateau pressure ≤ 30 cm H2O |
| Ventilator liberation protocol26,51 | Percentage of ventilator days with protocol screening and completion |
| Cardiac | |
| Severe sepsis bundle52, a | Percentage of patients with severe sepsis for whom lactate level was measured, blood culture obtained prior to antibiotic administration, and broad-spectrum antibiotics administered within 3 h |
| Septic shock bundle52, a | Percentage of patients with septic shock for whom the severe sepsis bundle was met within 3 h and vasopressors were administered, central venous pressure and central venous oxygen saturation were measured, and lactate level was rechecked (if initially ≥ 4 mmol/L) within 6 h |
| Infectious disease | |
| Hand hygiene compliance53 | Percentage of opportunities where health-care workers adhered to hand hygiene guidelines |
| Blood cultures for CAP54,55, a | Percentage of ICU patients with CAP with one or more sets of blood cultures performed within 24 h prior to or 24 h after hospital admission |
| CVC insertion protocol36, a | Percentage of CVC insertions in which the CVC was inserted with all elements of maximal sterile barrier technique (cap AND mask AND sterile gown AND sterile gloves AND large sterile sheet AND hand hygiene AND 2% chlorhexidine for cutaneous antisepsis) |
| GI | |
| Stress ulcer prophylaxis26 | Percentage of ventilator days with stress ulcer prophylaxis administration |
| Enteral nutrition56 | Percentage of patients receiving enteral nutrition within 24 h of ICU admission |
| Hematologic | |
| DVT prophylaxis57, a | Percentage of patient days with DVT prophylaxis administration |
| Appropriate use of blood transfusions58, b | Percentage of nonbleeding, hemodynamically stable patients receiving any RBC transfusion with a pretransfusion hemoglobin level ≤ 7 g/dL |
| Palliative | |
| Surrogate decision-maker59, b | Percentage of patients for whom a surrogate decision-maker or the absence of a surrogate is documented within 24 h of ICU admission |
| Goals of care59 | Percentage of patients for whom goals of care are documented within 72 h of ICU admission |
CAP = community-acquired pneumonia; CVC = central venous catheter.
a
National Quality Forum endorsed.
b
Critical Care Societies Collaborative22 and American Board of Internal Medicine “Choosing Wisely” endorsed.