Co-designed and consensus based development of a quality improvement checklist of patient and family-centered actionable processes of care for adults with persistent critical illness

• Published in: Journal of critical care 2022-12, Vol.72, p.154153-154153, Article 154153
• Main Authors: Rose, Louise, Istanboulian, Laura, Amaral, Andre Carlos Kajdacsy-Balla, Burry, Lisa, Cox, Christopher E., Cuthbertson, Brian H., Iwashyna, Theodore J., Dale, Craig M., Fraser, Ian
• Format: Article
• Language: English
• Subjects: Adult; Checklist; Chronic critical illness; Chronic Disease; Chronic illnesses; Consensus; Content analysis; Critical care; Critical Care - methods; Critical Illness - therapy; Humans; Intensive care; Intensive Care Units; Interviews; Meetings; Patient-centered care; Patients; Persistent critical illness; Process of care; Quality Improvement; Questionnaires; Social networks; Software; Systematic review; Ventilator Weaning; Ventilators
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2022.154153

Few quality improvement tools specific to patients with persistent or chronic critical illness exist to aid delivery of high-quality care. Using experience-based co-design methods, we sought consensus from key stakeholders on the most important actionable processes of care for inclusion in a quality improvement checklist. Item generation methods: systematic review, semi-structured interviews (ICU survivors and family) members, touchpoint video creation, and semi-structured interviews (ICU clinicians). Consensus methods: modified online Delphi and a virtual meeting using nominal group technique methods. We enrolled 138 ICU interprofessional team, patients, and family members. We obtained consensus on a quality improvement checklist comprising 11 core domains: patient and family involvement in decision-making; patient communication; physical comfort and complication prevention; promoting self-care and normalcy; ventilator weaning; physical therapy; swallowing; pharmacotherapy; psychological issues; delirium; and appropriate referrals. An additional 27 actionable processes are contained within 6 core domains that provide more specific direction on the actionable process to be targeted. Using a highly collaborative and methodologically rigorous process, we generated a quality improvement checklist of actionable processes to improve patient and family-centred care considered important by key stakeholders. Future research is needed to understand optimal implementation strategies and impact on outcomes and experience. •Adults with persistent critical illness have complex recovery needs requiring an change in care goals and care planning•Quality improvement tools or metrics to aid in the delivery of high-quality care for this patient population are lacking•We provide evidence for the actionable processes of care important for inclusion in a quality improvement checklist