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Identifying Low Value Care Practices in UK Paediatric Intensive Care Units in 2025: A Delphi Study
Lyvonne N Tume1, Lindsay Kenworthy2, Emma C Alexander3
1Edge Hill University & Alder Hey Children's NHS FT, Ormskirk, UK.
Insights
This study identified top low-value care practices in UK Paediatric Intensive Care Units (PICUs) for de-implementation. Key areas include medication overprescribing and prolonged fasting after extubation.
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.
Background:
Low-value care, is care that is ineffective, inefficiently delivered or unwanted and is common in high income settings. The United Kingdom (UK) Paediatric Critical Care Society (PCCS) established a de-implementation working group in October 2024.
Aim:
The aim of the study was to identify and then prioritise low-value care practices for de-implementation across UK Paediatric Intensive Care Units (PICUs) over the next 5 years and to ascertain which practices staff would be prepared to de-implement based on current evidence, and for which further evidence is required.
Study Design:
A modified three round Delphi study was undertaken between December 2024 and May 2025. In Round 1, PICUs submitted their top low-value care practices. These were entered into an electronic survey (Round 2) for prioritisation. These were analysed according to a predefined consensus definition. The final survey (Round 3), including these items, plus any new items suggested at Round 2, were re-ranked considering the group mean score.
Results:
Thirty-seven items were submitted from 16 PICUs (these were unit responses) in Round 1. One hundred thirty-five staff completed Round 2, and 14 of these 37 items met the criteria for inclusion in Round 3. Five new items were added to Round 3. One hundred eighteen staff voted on 19 items in Round 3. The top five practices ranked by mean score were (1) overprescribing of medications and not deprescribing them once not required, (2) fasting children for prolonged periods after extubation, (3) unnecessary use of non-sterile gloves, (4) continuing hourly observations in ward-ready patients and (5) taking routine blood tests.
Conclusions:
This is the first study to gain consensus on low-value care practices to be de-implemented in UK PICUs.
Relevance To Clinical Practice:
Low-value care practices are wasteful, both financially and environmentally, and impact on healthcare professionals' workload. Identification of these practices will enable future work to de-implement them.
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