Schults, Jessica A; Charles, Karina R; Millar, Johnny; Rickard, Claire M; Chopra, Vineet; Lake, Anna; Gibbons, Kristen; Long, Debbie; Rahiman, Sarfaraz; Hutching, Katrina; Winderlich, Jacinta; Spotswood, Naomi E; Johansen, Amy; Secombe, Paul; Pizimolas, Georgina A; Tu, Quyen; Waak, Michaela; Allen, Meredith; McMullan, Brendan; Hall, Lisa

Author(s)

Schults, Jessica A

Charles, Karina R

Millar, Johnny

Rickard, Claire M

Chopra, Vineet

Lake, Anna

Gibbons, Kristen

Long, Debbie

Rahiman, Sarfaraz

Hutching, Katrina

Winderlich, Jacinta

Spotswood, Naomi E

Johansen, Amy

Secombe, Paul

Pizimolas, Georgina A

Tu, Quyen

Waak, Michaela

Allen, Meredith

McMullan, Brendan

Hall, Lisa

Publication Date

2024-03-25

Abstract

Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.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.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.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.None.Priorities for quality measures.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.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.

Affiliation

Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia.

School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.

The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.

The University of Queensland Centre for Clinical Research, Queensland, Australia.

Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia.

School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.

The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.

Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.

Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia.

School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia.

School of Nursing and Midwifery, Griffith University, Queensland, Australia.

The University of Queensland Centre for Clinical Research, Queensland, Australia.

Department of Medicine, University of Colorado School of Medicine, Aurora, United States.

The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

School-based Youth Health Nursing Service, Child and Youth Community Health Service, Children's Health Queensland, Australia.

The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.

School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.

Faculty of Medicine, University of Queensland, Brisbane, Australia.

Paediatric Intensive Care Unit, Starship Child Health, Auckland, New Zealand.

Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia.

Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.

Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia.

Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia.

Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne Victoria, Australia.

Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.

Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, Victoria, Australia.

Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.

Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia.

School of Medicine, Flinders University, Bedford Park, South Australia, Australia.

School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.

Pharmacy, Queensland Children's Hospital, South Brisbane Queensland, Australia.

The University of Queensland Centre for Clinical Research, Queensland, Australia.

The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.

Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia.

Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia.

Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.

Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.

Sydney Children's Hospital, Randwick, Sydney, Australia.

Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia.

School of Public Health, University of Queensland, Queensland, Australia.

Citation

Crit Care Resusc . 2024 Mar 25;26(2):71-79. doi: 10.1016/j.ccrj.2024.01.002. eCollection 2024 Jun.

ISSN

1441-2772

OrcId

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/39072236/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/13492

Subject

Consensus

Critical care

Patient safety

Pediatrics

Quality indicators

Surveillance

MESH subject

Title

Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Schults, Jessica A Charles, Karina R Millar, Johnny Rickard, Claire M Chopra, Vineet Lake, Anna Gibbons, Kristen Long, Debbie Rahiman, Sarfaraz Hutching, Katrina Winderlich, Jacinta Spotswood, Naomi E Johansen, Amy Secombe, Paul Pizimolas, Georgina A Tu, Quyen Waak, Michaela Allen, Meredith McMullan, Brendan Hall, Lisa
Publication Date	2024-03-25
Abstract	Monitoring healthcare quality is challenging in paediatric critical care due to measure variability, data collection burden, and uncertainty regarding consumer and clinician priorities.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.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.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.None.Priorities for quality measures.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.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.
Affiliation	Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia. School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia. The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. The University of Queensland Centre for Clinical Research, Queensland, Australia. Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia. School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia. The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia. Murdoch Children's Research Institute, Melbourne, Victoria, Australia. Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia. School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia. School of Nursing and Midwifery, Griffith University, Queensland, Australia. The University of Queensland Centre for Clinical Research, Queensland, Australia. Department of Medicine, University of Colorado School of Medicine, Aurora, United States. The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. School-based Youth Health Nursing Service, Child and Youth Community Health Service, Children's Health Queensland, Australia. The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Faculty of Medicine, University of Queensland, Brisbane, Australia. Paediatric Intensive Care Unit, Starship Child Health, Auckland, New Zealand. Nutrition and Dietetics, Monash Children's Hospital, Melbourne, Australia. Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia. Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia. Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia. Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne Victoria, Australia. Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia. Paediatric Intensive Care Unit, The Royal Children's Hospital Melbourne, Victoria, Australia. Paediatric Intensive Care Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia. Intensive Care Unit, Alice Springs Hospital, Alice Springs (Mparntwe), Northern Territory, Australia. School of Medicine, Flinders University, Bedford Park, South Australia, Australia. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Pharmacy, Queensland Children's Hospital, South Brisbane Queensland, Australia. The University of Queensland Centre for Clinical Research, Queensland, Australia. The Children's Intensive Care Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. Paediatric Intensive Care Unit, Queensland Children's Hospital, Queensland, Australia. Paediatric Intensive Care Unit, Monash Children's Hospital, Melbourne, Victoria, Australia. Department of Paediatrics, Monash University, Melbourne, Victoria, Australia. Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia. Sydney Children's Hospital, Randwick, Sydney, Australia. Herston Infectious Diseases Institute, Metro North Hospital and Health Service, Queensland, Australia. School of Public Health, University of Queensland, Queensland, Australia.
Citation	Crit Care Resusc . 2024 Mar 25;26(2):71-79. doi: 10.1016/j.ccrj.2024.01.002. eCollection 2024 Jun.
ISSN	1441-2772
OrcId
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/39072236/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/13492
Subject	Consensus Critical care Patient safety Pediatrics Quality indicators Surveillance
MESH subject
Title	Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process.
Type of document	Journal Article
Entity Type	Publication

Establishing a paediatric critical care core quality measure set using a multistakeholder, consensus-driven process.

Files: