The need to measure the clinical effectiveness of intensive care

While all three aspects of the quality of care are important, it is clear that issues of equity and humanity are less relevant if the care being provided is either ineffective or harmful. Therefore the priority for any type of care, including intensive care, is to evaluate and audit its clinical effectiveness.

Intensive care has developed over the past 50 years with very little rigorous scientific evidence as to what is, or is not, clinically effective. Despite the enormous expenditure of resources on a relatively small number of intensive care patients, those delivering intensive care often have to decide which patients can benefit most in the absence of knowledge derived from rigorous scientific studies regarding the likelihood of successful treatment.

Whereas evaluation of the clinical effectiveness of intensive care through research requires the measurement of outcomes, audit of intensive care can be achieved by measuring either processes or outcomes. However, process audit should only be employed when the clinical effectiveness of the intervention being audited has already been demonstrated through rigorous evaluative research. Process audit can then be useful in assessing the appropriate use of clinically effective interventions in intensive care. Process audit cannot assess the impact of the overall package (combination of interventions) of intensive care. Outcome audit is essential to do this.

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