Identifying Low Value Care Practices in UK Paediatric Intensive Care Units in 2025: A Delphi Study

Area of Science:

• Pediatric Critical Care Medicine
• Healthcare Management
• Quality Improvement in Healthcare

Background:

• Low-value care, defined as ineffective, inefficient, or unwanted medical practices, is prevalent in high-income countries.
• The UK Paediatric Critical Care Society (PCCS) established a dedicated de-implementation working group in October 2024 to address this issue.

Purpose of the Study:

• To identify and prioritize low-value care practices within UK Paediatric Intensive Care Units (PICUs) for de-implementation over the next five years.
• To determine which practices healthcare staff are willing to de-implement based on existing evidence and where further evidence is needed.

Main Methods:

• A modified three-round Delphi study was conducted between December 2024 and May 2025.
• Paediatric Intensive Care Units (PICUs) initially submitted low-value care practices, followed by electronic surveys for prioritization and ranking by healthcare staff.

Main Results:

• Thirty-seven low-value care practices were submitted by 16 PICUs in the initial round.
• Following two rounds of surveys involving 135 and 118 staff respectively, five key practices were prioritized for de-implementation: medication overprescribing, prolonged fasting post-extubation, unnecessary non-sterile glove use, continued hourly observations for stable patients, and routine blood tests.

Conclusions:

• This research represents the first study to achieve consensus on low-value care practices targeted for de-implementation in UK PICUs.
• Identifying and addressing these wasteful practices is crucial for improving financial and environmental efficiency, reducing healthcare professional workload, and enabling future de-implementation initiatives.