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Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process
Jessica A Schults1,2,3,4,5, Karina R Charles1,2,3,4, Johnny Millar6,7
1Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia.
Insights
A 51-item core quality measure set for paediatric critical care was developed, aligning with patient and clinician priorities. This aims to improve healthcare quality monitoring and reduce data collection burdens.
Area of Science:
- Healthcare quality improvement
- Paediatric critical care research
- Health services research
Background:
- Monitoring healthcare quality in paediatric critical care is complex due to varied measures and data collection challenges.
- Establishing consistent quality metrics is vital for improving patient outcomes and care standards.
Purpose of the Study:
- To develop a core set of quality measures for paediatric critical care.
- To ensure measures are meaningful to both consumers (patients/families) and clinicians.
- To promote aligned use and collection of quality measures across the field.
Main Methods:
- A multi-stakeholder Delphi study combined with a consumer prioritisation survey.
- Involved Australian and New Zealand paediatric critical care survivors, families, clinicians, and policymakers.
- Triangulation of survey data preceded a consensus meeting to finalize the measure set.
Main Results:
- Consumers prioritized nurse-patient ratios, visible patient goals, and long-term follow-up.
- Clinicians agreed on a 51-item core measure set, prioritizing nurse-patient ratios, staff turnover, and long-term follow-up.
- Feasibility was rated low due to data collection burden and lack of standardized definitions.
Conclusions:
- A 51-item core measurement set for paediatric critical care has been defined, reflecting clinician and consumer priorities.
- Implementation and evaluation of this set are recommended for quality programs.
- Future work should address measure feasibility and consider retiring redundant measures.
Introduction:
Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.
Objective:
We sought to establish a core quality measure set that (i) is meaningful to consumers and clinicians and (ii) promotes alignment of measure use and collection across paediatric critical care.
Design:
We conducted a multi-stakeholder Delphi study with embedded consumer prioritisation survey. The Delphi involved two surveys, followed by a consensus meeting. Triangulation methods were used to integrate survey findings prior tobefore the consensus meeting. In the consensus panel, broad agreement was reached on a core measure set, and recommendations were made for future measurement directions in paediatric critical care.
Setting And Participants:
Australian and New Zealand paediatric critical care survivors (aged >18 years) and families were invited to rank measure priorities in an online survey distributed via social media and consumer groups. A concurrent Delphi study was undertaken with paediatric critical care clinicians, policy makers, and a consumer representative.
Interventions:
None.
Main Outcome Measures:
Priorities for quality measures.
Results:
Respondents to the consumer survey (n = 117) identified (i) nurse-patient ratios; (ii) visible patient goals; and (iii) long-term follow-up as their quality measure priorities. In the Delphi process, clinicians (Round 1 n = 191; Round 2 n = 117 [61% retention]; Round 3 n = 14) and a consumer representative reached broad agreement on a 51-item (61% of 83 initial measures) core measure set. Clinician priorities were (i) nurse-patient ratio; (ii) staff turnover; and (iii) long term-follow up. Measure feasibility was rated low due to a perceived lack of standardised case definitions or data collection burden. Five recommendations were generated.
Conclusions:
We defined a 51-item core measurement set for paediatric critical care, aligned with clinician and consumer priorities. Next steps are implementation and methodological evaluation in quality programs, and where appropriate, retirement of redundant measures.
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