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Development of a simple, practice-based tool to assess quality of paediatric emergency care delivery in
Rajesh Kirit Daftary1, Brittany Lee Murray2,3, Teri Ann Reynolds1,4
1Department of Emergency Medicine, University of California, San Francisco, California, USA.
Insights
Developing a practice-based tool identified 28 critical actions for managing critically ill children in African emergency departments. This tool aids in identifying care gaps and supports quality improvement initiatives for pediatric resuscitation.
Area of Science:
- Pediatric Emergency Medicine
- Global Health
- Quality Improvement Science
Background:
- Providing timely, high-quality care for critically ill children in African hospitals presents significant challenges.
- Monitoring critical actions during resuscitation is crucial for reducing variability and improving patient outcomes.
Purpose of the Study:
- To develop a practice-based tool for the initial management of critically ill children in African settings.
- To identify gaps in care and facilitate targeted training and standardized assessment for quality improvement.
Main Methods:
- A modified Delphi process involving an expert panel (84% from African settings) was used.
- Six sentinel conditions were selected based on African disease epidemiology and mortality.
- A literature review and logistical filters refined candidate actions into a practice-based tool.
Main Results:
- An expert panel generated 199 potential actions for six conditions in critically ill children.
- After applying appropriateness criteria, 92 candidate actions were identified across seven categories.
- A final tool includes 28 contextually relevant actions for initial pediatric emergency care in Africa.
Conclusions:
- A consensus process identified critical actions for managing severely ill children in African emergency settings.
- The absence of these actions may indicate modifiable gaps in the quality of care.
- The developed tool is contextually relevant and can support training and quality improvement in African hospitals.
Objective:
Provision of timely, high-quality care for the initial management of critically ill children in African hospitals remains a challenge. Monitoring the completion of critical actions during resuscitations can inform efforts to reduce variability and improve outcomes. We sought to develop a practice-based tool based on contextually relevant actions identified via a Delphi process. Our goal was to develop a tool that could identify gaps in care, facilitate identification of training and standardised assessment to support quality improvement efforts.
Design:
Six sentinel conditions were selected based on disease epidemiology and mortality at rural and urban African emergency departments. Potential critical actions were identified through focused literature review. These actions were evaluated within a three-round modified Delphi process. A set of logistical filters was applied to the candidate list to derive a practice-based tool.
Setting And Participants:
Attendees at an international emergency medicine conference comprised an expert panel of 25 participants, with 84% working primarily in African settings. Consensus rounds allowing novel responses were conducted via online and in-person surveys.
Results:
The expert panel generated 199 actions that apply to six conditions in emergently ill children. Application of appropriateness criteria refined this to 92 candidate actions across the following seven categories: core skills, active seizure, altered mental status, diarrhoeal illness, febrile illness, respiratory distress and polytrauma. From these, we identified 28 actions for inclusion in a practice-based tool contextually relevant to the initial management of critically ill children in Africa.
Conclusions:
A group consensus process identified critical actions for severely ill children with select sentinel conditions in emergency paediatric care in an African setting. Absence of these actions during resuscitation might reflect modifiable gaps in quality of care. The resulting practice-based tool is context relevant and can serve as a foundation for training and quality improvement efforts in African hospitals and emergency departments.
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