National registries: Lessons learnt from quality improvement initiatives in intensive care

J Crit Care. 2020 Dec:60:311-318. doi: 10.1016/j.jcrc.2020.08.012. Epub 2020 Aug 18.


National clinical quality registries (CQRs) are effective tools for improving the outcomes of patients admitted to the intensive care unit (ICU), and are increasingly important as healthcare needs evolve. A high-quality ICU CQR is built from a foundation of common requirements and challenges. First, performance indicators of the structure, process, or outcomes of patient care should measure what is important. Second, high data quality is essential and can be collected and curated through standardized processes. Third, standardized mortality ratio (SMR) is a cornerstone for benchmarking ICU performance, but application requires a comprehensive understanding of its context and potential pitfalls. Fourth, data collection alone is insufficient. Quality improvement comes from closing the feedback loop by identifying and managing unwarranted practice variation. Fifth, the process of improving healthcare is fundamentally a human enterprise, subject to behavioural change, including those that modify performance. Sixth, ICU CQRs must be dynamic to meet the needs of an evolving healthcare system and stakeholders. Finally, these lessons are far from comprehensive. Sharing perspectives on the development of ICU CQRs can help maximise their value as a powerful platform for informing policy development and improving the outcomes of patients admitted to the ICU.

Keywords: Clinical quality registries; Critical care; Database; Quality improvement.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Benchmarking
  • Critical Care / trends*
  • Data Accuracy
  • Databases, Factual
  • Delivery of Health Care / trends*
  • Hospitalization
  • Humans
  • Intensive Care Units / standards
  • Quality Improvement*
  • Quality of Health Care / trends*
  • Registries*
  • Stakeholder Participation