Paediatric intensive care 'do not do' recommendations in Spain: Selection by Delphi method
Ángel A Hernández Borges1, Alejandro Jiménez Sosa2, Rosalía Pérez Hernández1
1UCIP, Servicio de Pediatría, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Insights
Spanish pediatric intensive care experts identified 26 "do not do" recommendations to improve patient safety and clinical effectiveness. These guidelines aim to eliminate ineffective, unsafe, or inefficient practices in pediatric intensive care units.
Area of Science:
- Pediatric Intensive Care Medicine
- Clinical Quality Improvement
- Evidence-Based Practice
Background:
- Healthcare practices can be ineffective, unsafe, or inefficient.
- Scientific societies and health authorities develop 'do not do' recommendations (DNDRs) to address these issues.
- There was a need for consensus-based DNDRs specific to pediatric intensive care in Spain.
Purpose of the Study:
- To select a consensus set of 'do not do' recommendations for pediatric intensive care in Spain.
- To identify and prioritize practices that should be avoided to enhance patient care quality.
Main Methods:
- A two-phase approach was used: initial DNDR proposal gathering and Delphi method-based selection.
- Practices were evaluated based on prevalence, risk severity, and modifiability.
- Consensus was reached through iterative evaluations by working group members of the Spanish Society of Pediatric Intensive Care (SECIP).
- The initial set of 182 DNDRs was reduced to 26 based on consensus evaluations.
Main Results:
- A total of 182 potential DNDRs were initially proposed by 30 intensivists.
- The Delphi method, involving 14 evaluators, narrowed down the recommendations to a final set of 26.
- The selected DNDRs primarily focus on improving clinical effectiveness and patient safety in pediatric intensive care.
Conclusions:
- A consensus-based set of DNDRs for Spanish pediatric intensive care was successfully established.
- These recommendations provide guidance to avoid unsafe, inefficient, or ineffective practices.
- The study outcomes are expected to contribute to improving the quality of clinical care in pediatric intensive care settings.
Introduction:
Health care is not free of ineffective, unsafe or inefficient diagnostic and therapeutic practices. To address this, different scientific societies and health authorities have proposed 'do not do' recommendations (DNDRs). Our goal was the selection by consensus of a set of DNDRs for paediatric intensive care in Spain.
Material And Method:
The research was carried out in 2 phases: first, gathering potential DNDRs; second, selecting the most important ones, using the Delphi method, based on the prevalence of the practice to be modified, the severity of its potential risks and the ease with which it could be modified. Proposals and evaluations were both made by members of working groups of the Sociedad Española de Cuidados Intensivos Pediátricos (SECIP, Spanish Society of Paediatric Intensive Care), coordinated by email. The initial set of DNDRs was reduced based on the coefficient of variation (<80%) of the corresponding evaluations.
Results:
A total of 182 DNDRs were proposed by 30 intensivists. The 14 Delphi evaluators managed to pare down the initial set to 85 DNDRs and, after a second round, to the final set of 26 DNDRs. The care quality dimensions most represented in the final set are clinical effectiveness and patient safety.
Conclusions:
This study allowed the selection by consensus of a series of recommendations to avoid unsafe, inefficient or ineffective practices in paediatric intensive care in Spain, which could be useful for improving the quality of clinical care in our field.
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