TY - JOUR
T1 - Codesign of a Quality Improvement Tool for Adults With Prolonged Critical Illness: A Modified Delphi Consensus Study
AU - Allum, Laura
AU - Pattison, Natalie
AU - Connolly, Bronwen
AU - Apps, Chloe
AU - Cowan, Katherine
AU - Flowers, Emily
AU - Hart, Nicholas
AU - Rose, Louise
N1 - © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine. This is an open access article distributed under the Creative Commons Attribution License, to view a copy of the license, see: https://creativecommons.org/licenses/by/4.0/
PY - 2024/9/12
Y1 - 2024/9/12
N2 - OBJECTIVES: Increasing numbers of patients experience a prolonged stay in intensive care. Yet existing quality improvement (QI) tools used to improve safety and standardize care are not designed for their specific needs. This may result in missed opportunities for care and contribute to worse outcomes. Following an experience-based codesign process, our objective was to build consensus on the most important actionable processes of care for inclusion in a QI tool for adults with prolonged critical illness. DESIGN: Items were identified from a previous systematic review and interviews with former patients, their care partners, and clinicians. Two rounds of an online modified Delphi survey were undertaken, and participants were asked to rate each item from 1 to 9 in terms of importance for effective care; where 1–3 was not important, 4–6 was important but not critical, and 7–9 was critically important for inclusion in the QI tool. A final consensus meeting was then moderated by an independent facilitator to further discuss and prioritize items. SETTING: Carried out in the United Kingdom. PATIENTS/SUBJECTS: Former patients who experienced a stay of over 7 days in intensive care, their family members and ICU staff. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We recruited 116 participants: 63 healthcare professionals (54%), 45 patients (39%), and eight relatives (7%), to Delphi round 1, and retained 91 (78%) in round 2. Of the 39 items initially identified, 32 were voted “critically important” for inclusion in the QI tool by more than 70% of Delphi participants. These were prioritized further in a consensus meeting with 15 ICU clinicians, four former patients and one family member, and the final QI tool contains 25 items, including promoting patient and family involvement in decisions, providing continuity of care, and structured ventilator weaning and rehabilitation. CONCLUSIONS: Using experience-based codesign and rigorous consensus-building methods we identified important content for a QI tool for adults with prolonged critical illness. Work is underway to understand tool acceptability and optimum implementation strategies.
AB - OBJECTIVES: Increasing numbers of patients experience a prolonged stay in intensive care. Yet existing quality improvement (QI) tools used to improve safety and standardize care are not designed for their specific needs. This may result in missed opportunities for care and contribute to worse outcomes. Following an experience-based codesign process, our objective was to build consensus on the most important actionable processes of care for inclusion in a QI tool for adults with prolonged critical illness. DESIGN: Items were identified from a previous systematic review and interviews with former patients, their care partners, and clinicians. Two rounds of an online modified Delphi survey were undertaken, and participants were asked to rate each item from 1 to 9 in terms of importance for effective care; where 1–3 was not important, 4–6 was important but not critical, and 7–9 was critically important for inclusion in the QI tool. A final consensus meeting was then moderated by an independent facilitator to further discuss and prioritize items. SETTING: Carried out in the United Kingdom. PATIENTS/SUBJECTS: Former patients who experienced a stay of over 7 days in intensive care, their family members and ICU staff. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We recruited 116 participants: 63 healthcare professionals (54%), 45 patients (39%), and eight relatives (7%), to Delphi round 1, and retained 91 (78%) in round 2. Of the 39 items initially identified, 32 were voted “critically important” for inclusion in the QI tool by more than 70% of Delphi participants. These were prioritized further in a consensus meeting with 15 ICU clinicians, four former patients and one family member, and the final QI tool contains 25 items, including promoting patient and family involvement in decisions, providing continuity of care, and structured ventilator weaning and rehabilitation. CONCLUSIONS: Using experience-based codesign and rigorous consensus-building methods we identified important content for a QI tool for adults with prolonged critical illness. Work is underway to understand tool acceptability and optimum implementation strategies.
KW - prolonged mechanical ventilation
KW - intensive care
KW - chronic critical illness
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85204243417&partnerID=8YFLogxK
U2 - 10.1097/CCE.0000000000001146
DO - 10.1097/CCE.0000000000001146
M3 - Article
C2 - 39263382
VL - 6
SP - 1
EP - 12
JO - Critical Care Explorations
JF - Critical Care Explorations
IS - 9
M1 - e1146
ER -