ICU Management & Practice, ICU Volume 5 - Issue 4 - Winter 2005

ICNARC – Promoting Improvements

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Kathryn Rowan Ph.D, Director, ICNARC,

London, UK


[email protected]



ICNARC is an independent, charitable company. Established in 1994, through an initial two-year grant from the UK government, it is now self-financing.


Kathryn Rowan describes the goals of the Intensive Care National Audit & Research Centre (ICNARC).


The Intensive Care National Audit & Research Centre (ICNARC) was established in response to a proposal to the UK government, following the UK APACHE II Study (Rowan et al.1993a&b, 1994). Aiming to improve organization and practice of critical care (both intensive and high dependency) in England, Wales and Northern Ireland, ICNARC has five main goals, which are described here.


Promoting Performance Improvement - The Case Mix Programme is a performance assessment programme, promoting continued improvement through the provision of routine feedback of comparative data on case mix, outcomes and activity, to facilitate local performance management. A specimen report can be found at Specified data are collected by trained data collectors from participating units and are extensively validated, both locally and centrally, before analysis and feedback (Rowan and Black 2000). The resultant Case Mix Programme Database has been independently rated as a high quality clinical database ( The database is used for routine feedback to units and also for secondary research studies (see below). Participation in the Case Mix Programme is voluntary and, with over 70%of adult, general (mixed medical/surgical) units participating, it runs on a cost-recovery basis with units paying a small annual contribution.


Promoting Research - ICNARC used consensus development methods to elicit direct input from staff in critical care units to develop and prioritise its national programme (see table 1) for research in critical care (Goldfrad et al. 2000; Vella et al. 2000). The large numbers of critical care units - both contributing data to the Case Mix Programme Database and collaborating, following invitation, in research studies - afford a large, representative sample to provide unbiased, scientific research evidence to influence health services policy at all levels (Harrison et al. 2004). The ongoing research programme includes studies evaluating critical care outreach services, teamwork and safety attitudes among critical care staff, patients’ experiences of critical care and international comparisons.


Promoting Quality in Audit and Research – ICNARC works to improve the quality of both audit and research predominantly through a programme of methodological research aimed at improving:

• risk prediction modelling (Harrison et al. 2005; Wunsch et al. 2004)

• diagnostic coding (De Keizer et al. 2000; Young et al. 2001)

• the validity and reliability of data (Rowan 1996), and

• the interpretation of analyses (Ridley and Rowan 1997, Rowan and Angus 2000).

ICNARC encourages user involvement in all aspects of the conduct and output from its audit and research, and encourages scientific rigour through education (Wunsch et al. 2005).


Promoting Evidence Based Practice-ICNARC hasactively contributed to the work of the Cochrane Collaboration in ensuring that all the relevant, rigorous, research evidence was identifiable and available, by coordinating the hand-searching of the emergency medicine and critical care literature for randomized controlled trials (Langham et al. 1999, Langham et al. 2002). ICNARC has also contributed to the growing body of reviews of the evidence on outcomes (Black et al. 2001), organizational factors (Carmel et al. 2001) and interventions (Grocott et al. 2004; Harvey et al. 2004; Langham et al. 2003). In addition, ICNARC staff and/or data contribute to both practice and policy discussions at all levels from local to national (Rowan et al. 2004).


Promoting Research Capacity- A number of critical care researchers, both nationally and internationally, collaborate with ICNARC often as part of Masters or Doctorate degrees. In addition, ICNARC encourages its own research staff to gain research training and contributes towards fees.

Author<br> Kathryn Rowan Ph.D, Director, ICNARC, London, UK Correspondence<br> [email protected] Website<br> Acknowledgement

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