Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury

Jilske A. Huijben, Eveline J.A. Wiegers, Nicolette F. De Keizer, Andrew I.R. Maas, David Menon, Ari Ercole, Giuseppe Citerio, Fiona Lecky, Lindsay Wilson, Maryse C. Cnossen, Suzanne Polinder, Ewout W. Steyerberg, Mathieu Van Der Jagt, Hester F. Lingsma, Marcel Aries, Rafael Badenes, Albertus Beishuizen, Federico Bilotta, Arturo Chieregato, Emiliano CingolaniMark Coburn, Jonathan P. Coles, Mark Delargy, Bart Depreitere, Hans Flaatten, Volodymyr Golyk, Erik Grauwmeijer, Iain Haitsma, Raimund Helbok, Cornelia Hoedemaekers, Bram Jacobs, Korné Jellema, Lars Owe D. Koskinen, Marc Maegele, Maria Cruz Martin Delgado, Kirsten Møller, Rui Moreno, David Nelson, Annemarie W. Oldenbeuving, Jean Francois Payen, Jasmina Pejakovic, Gerard M. Ribbbers, Rolf Rossaint, Guus Geurt Schoonman, Luzius A. Steiner, Nino Stocchetti, Fabio Silvio Taccone, Riikka Takala, Olli Tenovuo, Eglis Valeinis, Walter M. Van Den Bergh, Thomas Van Essen, Nikki Van Leeuwen, Michael H.J. Verhofstad, Pieter E. Vos

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3 Citations (Scopus)


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.

Original languageEnglish
Article number95
JournalCritical Care
Issue number1
Publication statusPublished - 22 Mar 2019


  • Benchmarking
  • Intensive care unit
  • Quality indicators
  • Quality of care
  • Trauma registry
  • Traumatic brain injury


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