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Quality indicators for high acuity pediatric conditions
Antonia S Stang1, Sharon E Straus, Jennifer Crotts
1MDCM, MBA, MSc, Alberta Children's Hospital, 2888 Shaganappi Trail, Calgary AB, T3B 6A8. antonia.stang@albertahealthservices.ca.
Insights
Researchers developed evidence-based quality indicators for high-acuity pediatric conditions in emergency departments (EDs). This systematic process involved multiple stakeholders to improve care for critically ill children.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Clinical Performance Measurement
Background:
- Improving outcomes for critically ill children necessitates evidence-based performance measures.
- Existing quality measures may not adequately address high-acuity pediatric conditions in emergency departments (EDs).
Purpose of the Study:
- To systematically identify and develop evidence-based quality indicators for high-acuity pediatric conditions.
- To create measures applicable to any emergency department (ED) setting providing pediatric care.
Main Methods:
- A prioritized list of conditions (e.g., diabetic ketoacidosis, sepsis) was established.
- A systematic literature review identified existing indicators and evidence.
- A Rand-modified Delphi method with expert consensus was employed for indicator selection and refinement.
Main Results:
- Sixty-two quality indicators were developed, primarily focusing on ED processes (84%).
- Key conditions included diabetic ketoacidosis, status asthmaticus, anaphylaxis, status epilepticus, severe head injury, and sepsis.
- 37% of indicators were supported by moderate to high-quality evidence, with acceptable data availability and reliability.
Conclusions:
- A systematic, stakeholder-driven process successfully developed evidence-based quality indicators for high-acuity pediatric conditions.
- Future research will assess the reliability and feasibility of data collection for these indicators across diverse ED settings.
Objective:
Identifying gaps in care and improving outcomes for severely ill children requires the development of evidence-based performance measures. We used a systematic process involving multiple stakeholders to identify and develop evidence-based quality indicators for high acuity pediatric conditions relevant to any emergency department (ED) setting where children are seen.
Methods:
A prioritized list of clinical conditions was selected by an advisory panel. A systematic review of the literature was conducted to identify existing indicators, as well as guidelines and evidence that could be used to inform the creation of new indicators. A multiphase, Rand-modified Delphi method consisting of anonymous questionnaires and a face-to-face meeting of an expert panel was used for indicator selection. Measure specifications and evidence grading were created for each indicator, and the feasibility and reliability of measurement was assessed in a tertiary care pediatric ED.
Results:
The conditions selected for indicator development were diabetic ketoacidosis, status asthmaticus, anaphylaxis, status epilepticus, severe head injury, and sepsis. The majority of the 62 selected indicators reflect ED processes (84%) with few indicators reflecting structures (11%) or outcomes (5%). Thirty-seven percent (n = 23) of the selected indicators are based on moderate or high quality evidence. Data were available and interrater reliability acceptable for the majority of indicators.
Conclusions:
A systematic process involving multiple stakeholders was used to develop evidence-based quality indicators for high acuity pediatric conditions. Future work will test the reliability and feasibility of data collection on these indicators across the spectrum of ED settings that provide care for children.
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