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

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.

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Déclaration de conflit d'intérêts

Declaration of Competing Interest Edward Litton is a member of the management committee of the ANZICS Centre for Outcome and Resources Evaluation and is supported by a National Health and Medical Research Council Early Career Fellowship. Bertrand Guidet has no conflicts of interest in relation to this work to declare. Dylan de Lange is board member of the Dutch National Intensive Care Evaluation (NICE) but has no other conflict of interest.