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SICSAG Home History |
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SICSAG History |
HistoryThe BeginningIn 1992 the recently formed Scottish Intensive Care Society set up a group to examine the potential for a National Audit of Intensive Care. Prior to this, studies had been run in Edinburgh and Glasgow to evaluate the practicality of routinely collecting audit data. The prime motivator was Dr ABM Telfer, the first President of the Society and a member of the Clinical Resource and Audit Group (CRAG) committee that had published guidelines for audit of intensive care in Scotland. A representative from each Scottish Intensive Care Unit attended a series of meetings during which a minimum dataset was agreed upon. Kathy Rowan, who had run the UK APACHE II study, and would ultimately head up the Intensive Care National Audit and Research Centre, attended a number of these meetings in an advisory role. A successful submission, written by Dr JC Howie and Dr NP Leary, was made to CRAG, with funding allocated for a 3-year period from July 1994. In the intervening period, Critical Care Audit (effectively Brian Millar) was contracted to provide software based on APACHE III. Costs were contained by agreeing to share data with APACHE Medical Systems Inc. in the United States who licensed the APACHE III system and were already supporting a similar audit in South West Thames as part of an international evaluation. The software package (Ward Watcher) was adapted to provide probabilities from other severity of illness systems (APACHE II, SAPS II & MPM II). The aims of the project were to establish a comprehensive audit facility and intensive care episode database within Scotland and compare the relative merits of the various severity of illness scoring systems for the Scottish ICU population. The remit of the staff, Mark Livingston and Fiona MacKirdy, was to establish the audit project: set-up and install the audit software, train ICU staff in data collection and severity of illness scoring methods, perform data validation, data analyses and feedback. Mark Livingston gained a PhD comparing the scoring tools. The PresentThe audit continued to be financially supported by CRAG for a total of 7 years. The external reviewers’ confidential reports at the final assessment were highly favourable. The intensive care audit is now funded by a central allocation from the Scottish Executive administered through the South Glasgow University NHS Trust. The audit provides a national electronic Bed Bureau, which allows real-time assessment of bed availability without the need for additional record keeping by ward staff. The SICS has formed a Clinical Trials Group to organise multi-centre research, making use of the audit structure. The audit has now been extended into many high dependency units. There is no central funding for this and units are required to pay for participation. A modified version of the Ward Watcher software is in development which will be more appropriate to use in HDU and in combined ICU/HDU units. StaffingFiona MacKirdy became Project Director in 1997. She has been assisted by audit nurses including Sandra Donaldson, Jane Ross (ARDS study), Dianne Currie, Lynn Gillies (HDU Audit), Alison MacLeod (HDU Audit), Gill Harris (Prospective sepsis study) and Linda Patterson (Drotrecogin alfa Audit). Due to the episodic nature of the funding, temporary contracts are only ever available to the audit staff. The quality of employment former staff members have attained subsequent to working with the audit group is testament to how highly the audit is regarded in Scotland. The core complement of staff remained at 2 (Fiona and Gill). Linda’s year with the audit group, assisting the implementation of the SICS Guidelines and the audit of Drotrecogin alfa (activated), comes to an end shortly. She took up a promoted post with the Effective Use of Blood Group in October 2003. Finance for the audit group to support the HDUs has enabled the group to secure assistance for database management and analyses from NHS Greater Glasgow. We have a contract for 1 year with the Board to provide the services of 1 WTE. Both Annette Little and Karen Lorenzetti have been working extensively with Fiona since February. Gill’s remit has altered from her initial 8-month contract assisting the prospective sepsis study. She is a key member of staff, helping develop the HDU audit. Software continues to be provided by Brian Millar (Critical Care Audit Ltd) but now independent of APACHE Medical Systems and with the APACHE III predictions removed. The Audit Group is accountable to the SICS. It has a steering group initially chaired by Cameron Howie now chaired by Simon Mackenzie. Participation in the audit is voluntary, however, it is pleasing to note that all adult general ICUs now participate to some extent in the audit. Throughout the life of the project an Annual Audit Meeting has provided the opportunity for critical evaluation of the data and an Annual Report has been produced which is made available to all participating hospitals and to CRAG. From the outset of the project we have provided a mechanism allowing intensive care staff to identify their own data at both meetings and in the annual report, whilst maintaining anonymity. We now only maintain anonymity for standardised mortality ratios, as these are data particularly prone to misinterpretation. Fiona Mackirdy resigned as project manager in 2006. She had been with the group since 1994. Over the years, Fiona played a pivotal role in the development and smooth running of SICSAG. She will be missed. Specific projectsIn the initial phase of the audit group we undertook a comparison of various severity of illness scoring systems (APACHE II & III, MPM II0 & MPM II24, SAPS II). Following this we concluded that APACHE II was the most appropriate and the dataset was, therefore, reduced by removing APACHE III fields. We continued to calculate SAPS II in addition to APACHE II in order to help assure the validity of the results. Specific projects have been undertaken with support from the pharmaceutical industry including AstraZeneca (Prospective, observational study of the Adult Respiratory Distress Syndrome), GlaxoWelcome (Structure & Process of renal replacement therapy) and Eli Lilly (Incidence of sepsis). These have been structured in such a way that the Society retains control of the data and how they are used. There has been payment to both the Audit Group and to individual units to cover the work involved. The database is now large enough to allow meaningful analysis of sub-groups. Specific projects have looked at haematological malignancy and ruptured abdominal aortic aneurysms. |
History |
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