History and Background of the Critical Care and Medicine Database
The ICU database was created in 1988 by Dr. Dan Roberts, when he was the head of the Section of Critical Care Medicine. Creating a database from scratch is a substantial endeavour: data elements must be chosen and clearly defined; collection rules decided upon; collection methods operationalized; and an electronic data storage plan made. A custom system of approximately 3000 diagnoses and procedures was devised. Data collection included the elements of the APACHE II score, enabling benchmarking and adjustment for case mix differences between subgroups and over time. Elements of the Therapeutic Intervention Scoring System (TISS) were collected to measure nursing workload. Data elements were included to assess aspects of medical resources used in caring for ICU patients. Dr. Roberts recruited an ICU nurse, Trish Ostryzniuk, to be the first data collector, and worked with a local company to create a software solution for data entry, storage and reporting.
In 1988 this database included only the Medical and Surgical ICUs at HSC. By 1999, powered by a cohort of former critical care nurses as data collectors, it came to encompass all adult ICUs in Winnipeg. Currently, the database is also supported by a statistician/programmer, systems analyst, data processor and a wiki that acts as a data dictionary, data collection guide, and repository of its changes over time.
Recognizing that Quality Improvement must be driven by systematically collected and analyzed data, the ICU database is the central focus of QI efforts within the Adult Critical Care Program of the WRHA. Quarterly reports to medical and nursing leadership of each of ICU report and compare severity-adjusted outcomes between ICUs,and within each ICU over time. The TISS data has been used to re-adjust nursing ratios in the various ICUs. One of the first [1] using data from the ICU database, appearing in The Lancet in 1991 describing controlling blood gas measurements in an ICU and another publication in 1993 in Critical Care Medicine, describing how the resource utilization data was leveraged to reduce unnecessary laboratory testing.
In 2003, the program expanded to include Internal Medicine wards at Health Sciences Centre, St. Boniface Hospital, Victoria General Hospital and Grace Hospital.
The database is regularly used for Accreditation. In 2013 the database was recognized as an Accreditation Canada Leading Practice.
A major leap in the value of the Winnipeg ICU database came in 2008, when it was linked with the provincial health data at the Manitoba Centre for Health Policy. Combining the clinical detail of the ICU database with all provincial administrative health data enables addressing a wide range of critical care-related questions. One of the first uses of the linked data was a comprehensive survey of the epidemiology of critical illness throughout Manitoba. Dozens of publications have resulted from this data linkage.
Work is ongoing to improve the usefulness of the ICU database. It now contains laboratory test values in addition to simple counts of tests performed. Changes currently in process include: coding using national standards, ICD-10 for diagnoses, and the Canadian Classification for Health Interventions for procedures; capturing the timing of procedures and acquired diagnoses; adding information about hospital admission and disposition; and linking to provincial death data to allow for analysis of mortality at any time point.
The Winnipeg ICU Database has proven to be a potent tool for research and Quality Improvement. In its isolated form it is available for use, free of charge, by all faculty in the Department of Medicine.
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