Enhancing Quality of Care Assessments: Managing Atypical Patients in ICU Benchmarking in The Netherlands
Authors' conclusion
The results highlight how atypical patients negatively affect mortality prediction accuracy and influence ICU quality assessments.
Study context
- Population
- Adult ICU patients fulfilling APACHE-IV inclusion criteria, 75 ICUs in The Netherlands, 2018–2023
- Participants
- 344,452 patients · 75 ICUs
- Exposure
- Atypical vs typical ICU patients
- Outcome
- APACHE-IV model performance (Brier score) and standardized mortality ratio (SMR)-based ICU benchmarking
Methodological detailsmulticentre, national ICU registry benchmarking
- Multicentre
- National ICU registry benchmarking
Main finding
As reported in the abstract
Brier score of APACHE-IV prediction model
Typical
0.02
Atypical
0.13
- ICUs whose benchmarking conclusion changed after excluding top 5% atypical patients (expected ↔ unexpected quality range)
- 13
Observational data: associations, not effects.
Further findings
- ICUs admitting the most atypical patients (of 75)
- 6
- Of these, academic hospitals
- 5
Original publication
Enhancing Quality of Care Assessments: Managing Atypical Patients in ICU Benchmarking in The Netherlands. Crit Care Med. Published 15 August 2025. doi:10.
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