Evidence-based Evaluation to Promote High-value Care in Pediatric Critical Care: It Is Time to Fully Adopt

Evidence-based recommendations for high-value care in pediatric critical care are needed. We sought to develop recommendations to identify unnecessary interventions, enhance outcomes, and promote efficient, patient-centered practices.

Using a modified Delphi process, a multi-institutional panel of pediatric intensivists from a national pediatric critical care quality improvement group identified 30 potential topics and selected 20 high- and medium-priority topics for further evaluation, and narrowed them to 10 by consensus voting. A structured scoping review of literature published between 2014 and 2023 identified 10 practices, which were critically assessed using the PICOST framework. The panel selected 5 priority recommendations based on evidence strength, feasibility, and potential impact.

The panel developed 5 evidence-based recommendations: (1) prioritize early and progressive mobilization in the pediatric intensive care unit, (2) avoid reflexive culture testing in febrile children without clinical signs of infection, (3) conduct daily tracheal extubation readiness assessments to prevent unnecessary delays, (4) limit red blood cell transfusions in stable, nonbleeding patients with hemoglobin greater than 7 g/dL, and (5) initiate enteral nutrition within 48 hours when clinically safe and feasible. Each recommendation is grounded in current best evidence and aims to minimize harm while optimizing resource use and outcomes.

Incorporating high-value care principles into pediatric critical care holds promise for reducing unwarranted variation, minimizing harm, and improving the efficiency and effectiveness of care. Future efforts should focus on implementation strategies, practice integration, and ongoing evaluation to sustain improvements and close the gap between evidence and adoption.