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

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.

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.

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.

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.

This is the first study to gain consensus on low-value care practices to be de-implemented in UK PICUs.

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.