Audit of critical care in NHSScotland
Reporting on 2024

About this release

This release by Public Heath Scotland and the Scottish Intensive Care Society Audit Group (SICSAG) presents a summary report of critical care unit adherence to SICSAG Minimum Standards and Quality Indicators (MSQIs). The information is self-reported by the critical care units and comes from an annual survey by SICSAG. The survey covered intensive care units (ICUs), combined ICU/HDU units, and stand-alone HDUs, including obstetric HDUs. The data collection platform used in all of the critical care units, is in the process of being upgraded, with the roll out expected to be completed by late 2025 ,however with some sites still on the old platform, the data analysis for the annual report has proved to be challenging leading to the decision to provide this summary report on the MSQI achievements.

Minimum standards are the measures of a structure, process or outcome that all units should meet. Adherence to minimum standards provides assurance to patients, the public and clinicians that units are providing an acceptable level of care that is deemed safe.

The MSQI response options are scored as follows:

1. Not implemented
2. Not implemented but a plan is in place to implement in next six months
3. Unit complies with this indicator in some patients but not all, or it is implemented but not documented in the majority of cases
4. Unit complies with this indicator in the vast majority of patients, or is implemented and documented in the vast majority of cases
5. This is fully embedded into unit practice and can evidence this fully if required

Units are considered to have met the standard if they achieve levels 4 or 5 and must report an action plan for improvement if 3 or below.

Main points

• All ICU or combined ICU/HDU units met at least half of the eight MSQIs for all patients. For the remaining four MSQIs, 95% of these units reported compliance, with only one unit not achieving each of them.
• None of the reported MSQIs were achieved by all HDUs. The lowest compliance was seen in twice-daily ward rounds and mortality and morbidity meetings, with only 76% of units meeting these indicators.
• Two health boards did not submit an action plan at the time of reporting to address their compliance with the MSQIs.

Background

This audit includes all ICUs and the majority of HDUs in NHS Scotland during 2024.

It is not possible to provide an accurate figure on the number of HDUs due to differing provisions across all specialties and NHS boards. However, it is estimated that more than 95% of all HDUs participated in this audit. The audit covers nearly 35,000 patients admitted to critical care units in NHSScotland during 2024.

SICSAG aims to improve the quality of care delivered to critical care patients by monitoring and comparing activities and outcomes. The audit of critical care is a co-ordinated quality improvement programme which provides data, analysis and feedback to raise standards and continued improvement in patient outcomes.

Critical care units have provided detailed comments where any MSQIs have not been met. The SICSAG team will monitor over the next year to ensure that the units are on trak with their action plans for improvement. The aim is that the units will meet this MSQI in 2025.

SICSAG are currently reviewing the MSQIs with the intention to provide a more focused, reduced list of SICSAG standards.  The final draft has been shared with the wider stakeholders and their feedback will be analysed over the coming weeks.