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Appears in Collections:Psychology Journal Articles
Peer Review Status: Refereed
Title: Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury
Author(s): Huijben, Jilske
Wiegers, Eveline
de Keizer, Nicolette
Maas, Andrew
Menon, David
Ercole, Ari
Citerio, Giuseppe
Lecky, Fiona
Wilson, Lindsay
Cnossen, Maryse
Polinder, Suzanne
Steyerberg, Ewout
van der Jagt, Mathieu
Lingsma, Hester
Keywords: Quality indicators
Traumatic brain injury
Intensive care unit
Trauma registry
Quality of care
Issue Date: 22-Mar-2019
Citation: Huijben J, Wiegers E, de Keizer N, Maas A, Menon D, Ercole A, Citerio G, Lecky F, Wilson L, Cnossen M, Polinder S, Steyerberg E, van der Jagt M & Lingsma H (2019) Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury. Critical Care, 23, Art. No.: 95.
Abstract: Background: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results: The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future
DOI Link: 10.1186/s13054-019-2377-x
Rights: © The Author(s). 2019 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
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