Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 12 ( 2017 ) > List of Articles


Evaluation of quality indicators in an Indian intensive care unit using “CHITRA” database

Kiran Gudivada

Keywords : Benchmark, critically ill, intensive care, quality indicators

Citation Information : Gudivada K. Evaluation of quality indicators in an Indian intensive care unit using “CHITRA” database. Indian J Crit Care Med 2017; 21 (12):841-846.

DOI: 10.4103/ijccm.IJCCM_303_17

License: CC BY-ND 3.0

Published Online: 01-07-2013

Copyright Statement:  Copyright © 2017; The Author(s).


Background: Quality indicators (QIs) are essential for maintaining quality of care in the critically ill. The Indian Society of Critical Care Medicine proposed benchmarks and enabled Indian Intensive Care Units (ICUs) to capture data in an electronic database: Customized Health in Intensive Care Trainable Research and Analysis (CHITRA) tool. The purpose of this study is to report QIs in an Indian ICU using this database. Materials and Methods: Data from patients admitted to ICU between October 2015 and January 2017 were entered into CHITRA. The following QIs were analyzed: standardized mortality ratio (SMR), length of ICU stay (LOS-ICU), pressure ulcer (PU) rate, patient fall rate (FR), ICU readmission rate, reintubation rate, ventilator-associated condition (VAC), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and iatrogenic pneumothorax rate. Results: A total of 2642 patient's information was suitable for analysis. Median age of ICU admission was 53 years (interquartile range [IQR]: 36–65), with a mean APACHE score of 18 (SD 7.7). Median LOS-ICU was 3 days (IQR 2–6) and SMR was 1.1 (95% confidence interval 1.05–1.38). Pneumothorax rate, PU rate, and FR were 2.6, 4.1, and 0.3 per 1000 respectively, whereas readmission rate was 0.7% and reintubation rate was 3.5%. VAC, CLABSI, and CAUTI were 8.5, 23, 3.1 per 1000 ventilator and catheter days, respectively. Conclusion: This study has successfully evaluated a range of QIs in a mixed ICU of a tertiary hospital utilizing CHITRA database.

PDF Share
  1. Small H. A Brief History of Florence Nightingale: And Her Real Legacy, a Revolution in Public Health. London, UK: Little, Brown Book Group; 2017.
  2. Wright JR Jr. The American College of Surgeons, minimum standards for hospitals, and the provision of high-quality laboratory services. Arch Pathol Lab Med 2017;141:704-17.
  3. The Joint Commission – Hospital Accreditation (JCAH). Available from: [Last accessed on 2017 May 15].
  4. Williamson JW, Wilson R. Assessing and Improving Health Care Outcomes: The Health Accounting Approach to Quality Assurance. Cambridge, MA: Ballinger Publication Co.; 1978.
  5. Donabedian A. The quality of care. How can it be assessed? JAMA 1988;260:1743-8.
  6. Delgado M, Pericas L, Moreno J, Torra L, Varela J, Suero F, Anuncibay P, Guiseris J. Quality indicators in critically ill patients. Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMISYUS); 2005.
  7. The Australian Council on Healthcare Standards (ACHS). Available from: [Last accessed on 2017 May 15].
  8. Ray B, Samaddar DP, Todi SK, Ramakrishnan N, John G, Ramasubban S, et al. Quality indicators for ICU: ISCCM guidelines for ICUs in India. Indian J Crit Care Med 2009;13:173-206.
  9. Sharma M, Aggarwal H. EHR adoption in India: Potential and the challenges. Indian J Sci Technol 2016;9:34.
  10. CHITRA – Customized, Health in Intensive Care, Trainable Research and Analysis Tool. Available from: [Last accessed on 2017 May 15].
  11. Mehta Y, Jaggi N, Rosenthal VD, Kavathekar M, Sakle A, Munshi N, et al. Device-associated infection rates in 20 cities of India, data summary for 2004-2013: Findings of the international nosocomial infection control consortium. Infect Control Hosp Epidemiol 2016;37:172-81.
  12. Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult Intensive Care Units. Crit Care Clin 2007;23:639-58.
  13. Glance LG, Osler T, Shinozaki T. Effect of varying the case mix on the standardized mortality ratio and W statistic: A simulation study. Chest 2000;117:1112-7.
  14. John J, Seifi A. Incidence of iatrogenic pneumothorax in the United States in teaching vs. Non-teaching hospitals from 2000 to 2012. J Crit Care 2016;34:66-8.
  15. Shea JD. Pressure sores: Classification and management. Clin Orthop Relat Res 1975;112:89-100.
  16. Sharp Health Care (SHARP). Malcolm Baldrige National Quality Award Application; 2007. Available from: [Last accessed on 2017 May 13].
  17. Barnett K, House R. Reducing Patient Falls Project. Dostopnona; 2008. Available from: pdf (1510 2009). [Last accessed on 2017 May 15].
  18. Bouldin EL, Andresen EM, Dunton NE, Simon M, Waters TM, Liu M, et al. Falls among adult patients hospitalized in the United States: Prevalence and trends. J Patient Saf 2013;9:13-7.
  19. Chen LM, Martin CM, Keenan SP, Sibbald WJ. Patients readmitted to the Intensive Care Unit during the same hospitalization: Clinical features and outcomes. Crit Care Med 1998;26:1834-41.
  20. Rosenberg AL, Watts C. Patients readmitted to ICUs: A systematic review of risk factors and outcomes. Chest 2000;118:492-502.
  21. Metnitz PG, Fieux F, Jordan B, Lang T, Moreno R, Le Gall JR, et al. Critically ill patients readmitted to Intensive Care Units – Lessons to learn? Intensive Care Med 2003;29:241-8.
  22. Cooper GS, Sirio CA, Rotondi AJ, Shepardson LB, Rosenthal GE. Are readmissions to the Intensive Care Unit a useful measure of hospital performance? Med Care 1999;37:399-408.
  23. McMillan TR, Hyzy RC. Bringing quality improvement into the Intensive Care Unit. Crit Care Med 2007;35:S59-65.
  24. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest 1997;112:186-92.
  25. Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: A 28-day international study. JAMA 2002;287:345-55.
  26. Mayo P, Volpicelli G, Lerolle N, Schreiber A, Doelken P, Vieillard-Baron A, et al. Ultrasonography evaluation during the weaning process: The heart, the diaphragm, the pleura and the lung. Intensive Care Med 2016;42:1107-17.
  27. Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 2005;33:2465-70.
  28. Raoof S, Baumann MH, Critical Care Societies Collaborative, consisting of the leadership of the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine. Ventilator-associated events: The new definition. Am J Crit Care 2014;23:7-9.
  29. Klompas M. Interobserver variability in ventilator-associated pneumonia surveillance. Am J Infect Control 2010;38:237-9.
  30. Klompas M, Kulldorff M, Platt R. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis 2008;46:1443-6.
  31. Zilberberg MD, Shorr AF. Ventilator-associated pneumonia: The clinical pulmonary infection score as a surrogate for diagnostics and outcome. Clin Infect Dis 2010;51 Suppl 1:S131-5.
  32. Magill SS, Klompas M, Balk R, Burns SM, Deutschman CS, Diekema D, et al. Developing a new, national approach to surveillance for ventilator-associated events. Am J Crit Care 2013;22:469-73.
  33. Warren DK, Shukla SJ, Olsen MA, Kollef MH, Hollenbeak CS, Cox MJ, et al. Outcome and attributable cost of ventilator-associated pneumonia among Intensive Care Unit patients in a suburban medical center. Crit Care Med 2003;31:1312-7.
  34. Rosenthal VD, Maki DG, Mehta A, Alvarez-Moreno C, Leblebicioglu H, Higuera F, et al. International nosocomial infection control consortium report, data summary for 2002-2007, issued January 2008. Am J Infect Control 2008;36:627-37.
  35. Magill SS, Li Q, Gross C, Dudeck M, Allen-Bridson K, Edwards JR, et al. Incidence and characteristics of ventilator-associated events reported to the national healthcare safety network in 2014. Crit Care Med 2016;44:2154-62.
  36. Critical Care Network in North West London – Ventilator care bundle. Available from: fldMenu=4&fldSubMenu=4&fldKey=186. [Last accessed on 2017 May 14].
  37. Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC, et al. National healthcare safety network (NHSN) report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008;36:609-26.
  38. Divatia JV, Amin PR, Ramakrishnan N, Kapadia FN, Todi S, Sahu S, et al. Intensive care in India: The Indian intensive care case mix and practice patterns study. Indian J Crit Care Med 2016;20:216-25.
  39. Amin N, Divatia J, Agarwal V, Kulkarni A. Readmissions in a surgical Intensive Care Unit: Patient characteristics and outcome. Indian J Crit Care Med 2003;7:14-7.
  40. Karthikeyan B, Kadhiravan T, Deepanjali S, Swaminathan RP. Case-mix, care processes, and outcomes in medically-ill patients receiving mechanical ventilation in a low-resource setting from Southern India: A Prospective clinical case series. PLoS One 2015;10:e0135336.
  41. Mathai AS, Phillips A, Isaac R. Ventilator-associated pneumonia: A persistent healthcare problem in Indian Intensive Care Units! Lung India 2016;33:512-6.
  42. Ranjan N, Chaudhary U, Chaudhry D, Ranjan KP. Ventilator-associated pneumonia in a tertiary care Intensive Care Unit: Analysis of incidence, risk factors and mortality. Indian J Crit Care Med 2014;18:200-4.
  43. Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the Intensive Care Unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med 2015;19:14-20.
  44. Datta P, Rani H, Chauhan R, Gombar S, Chander J. Health-care-associated infections: Risk factors and epidemiology from an Intensive Care Unit in Northern India. Indian J Anaesth 2014;58:30-5.
  45. Kazi MM, Harshe A, Sale H, Mane D, Minal Y, Chabukswar S. Catheter associated urinary tract infections (CAUTI) and antibiotic sensitivity pattern from confirmed cases of CAUTI in a tertiary care hospital: A prospective study. J Clin Microbiol 2015;4:193.
  46. Koenig SM, Truwit JD. Ventilator-associated pneumonia: Diagnosis, treatment, and prevention. Clin Microbiol Rev 2006;19:637-57.
  47. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32.
  48. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line-Associated Bloodstream Infection). Available from: [Last accessed on 2017 May 15].
  49. Urinary Tract Infection (Catheter-Associated Urinary Tract Infection [CAUTI] and Non-Catheter-Associated Urinary Tract Infection [UTI]) and Other Urinary System Infection [USI]) Events. Available from: [Last accessed on 2017 May 15].
  50. Agrawal A, Gandhe M, Gandhe S, Agrawal N. Study of length of stay and average cost of treatment in medicine Intensive Care Unit at tertiary care center. J Health Res Rev 2017;4:24-9.
  51. Babu A, Madhavan K, Singhal M, Sagar S, Ranjan P. Pressure ulcer surveillance in neurotrauma patients at a level one trauma centre in India. Oman Med J 2015;30:441-6.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.