Abstract
Background/aim
The objective of this study was to describe current surveillance platforms which support
routine quality measurement in paediatric critical care.
Method
Scoping review. The search strategy consisted of a traditional database and grey literature
search as well as expert consultation. Surveillance platforms were eligible for inclusion
if they collected measures of quality in critically ill children.
Results
The search strategy identified 21 surveillance platforms, collecting 57 unique outcome
(70%), process (23%), and structural (7%) quality measures. Hospital-associated infections
were the most commonly collected outcome measure across all platforms (n = 11; 52%).
In general, case definitions were not harmonised across platforms, with the exception
of nationally mandated hospital-associated infections (e.g., central line–associated
blood stream infection). Data collection relied on manual coding. Platforms typically
did not provide an evidence-based rationale for measures collected, with no identifiable
reports of co-designed, consensus-derived measures or consumer involvement in measure
selection or prioritisation.
Conclusions
Quality measurement in critically ill children lacks uniformity in definition which
limits local and international benchmarking. Current surveillance activities for critically
ill children focus heavily on outcome measurement, with process, structural, and patient-reported
measures largely overlooked. Long-term outcome measures were not routinely collected.
Harmonisation of paediatric intensive care unit quality measures is needed and can
be achieved using prioritisation and consensus/co-design methods.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Australian Critical CareAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Measuring healthcare quality.in: Busse R.K.N. Klazinga N. Panteli D. Quentin W. Improving healthcare quality in Europe: characteristics, effectiveness and implementation of different strategies. European Observatory on health systems and policies, Copenhagen2019
- Making care better in the pediatric intensive care unit.Transl Pediatr. 2018; 7: 267-274https://doi.org/10.21037/tp.2018.09.10
- The business case for preventing ventilator-associated pneumonia in pediatric intensive care unit patients.Joint Comm J Qual Patient Saf. 2008; 34 ([published Online First: 2008/11/26]): 629-638https://doi.org/10.1016/s1553-7250(08)34080-x
- Ventilator-associated events: definitions and uses.Reference Module in Biomedical Sciences. 2019; (B978-0-12-801238-3) ([published Online First: 11/23]): 11482-11485https://doi.org/10.1016/B978-0-12-801238-3.11482-5
- Ventilator-associated pneumonia in the pediatric intensive care unit: characterizing the problem and implementing a sustainable solution.J Pediatr. 2009; 154 ([published Online First: 2008/12/05]): 582-587.e2https://doi.org/10.1016/j.jpeds.2008.10.019
- Quality improvement in the PICU – a primer for intensivists.ICU Management & Practice. 2019; 19: 2019
- Research as a standard of care in the PICU.Pediatr Crit Care Med. 2016; 17: e13-e21https://doi.org/10.1097/PCC.0000000000000562
- Health Policy Analysis. Analysis of hospital-acquired diagnoses and their effect on case complexity and resource use – final report.ACSQHC, Sydney, Australia2013
- Australasian clinical indicator report: 2011-2018: 20th edition.20 ed. ACHS, Sydney, Australia2019: 137
- Decreasing PICU catheter-associated bloodstream infections: NACHRI’s quality transformation efforts.Pediatrics. 2010; 125 ([published Online First: 2010/01/13]): 206-213https://doi.org/10.1542/peds.2009-1382
- Reducing PICU central line-associated bloodstream infections: 3-year results.Pediatrics. 2011; 128 ([published Online First: 2011/10/26]): e1077-e1083https://doi.org/10.1542/peds.2010-3675
- (ACSQHC). Hospital-acquired complications (HACs): ACSQHC.([Available from:)
- A trigger tool to detect harm in pediatric inpatient settings.Pediatrics. 2015; 135 ([published Online First: 2015/05/20]): 1036-1042https://doi.org/10.1542/peds.2014-2152
- Identifying pediatric patients at high risk for adverse events in the hospital.Hosp Pediatr. 2018; (hpeds.2018-0171)https://doi.org/10.1542/hpeds.2018-0171
- A scoping review of online repositories of quality improvement projects, interventions and initiatives in healthcare.BMJ Quality & Safety. 2017; 26: 296https://doi.org/10.1136/bmjqs-2015-005092
- Scoping studies: towards a methodological framework.Int J Soc Res Methodol. 2005; 8: 19-32https://doi.org/10.1080/1364557032000119616
- Scoping review of potential quality indicators for hip fracture patient care.BMJ Open. 2017; 7e014769https://doi.org/10.1136/bmjopen-2016-014769
- Patient safety in marginalised groups: a narrative scoping review.Int J Equity Health. 2020; 19 (26-26)https://doi.org/10.1186/s12939-019-1103-2
- Scoping studies: advancing the methodology.Implement Sci: ISCUS. 2010; 5 ([published Online First: 2010/09/22]): 69https://doi.org/10.1186/1748-5908-5-69
- Australian's health performance framework.Australian Government, 2020 ([Available from:)https://www.aihw.gov.au/reports-data/australias-health-performance/australias-health-performance-frameworkDate accessed: August , 2020
- Hospital-acquired complications (HACs) list - specifications - version 3.0.ACSQHC, 2019
- Quality measures: Centres for medicare & medicaid services.2021 ([Available from:)https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasuresDate accessed: September 24, 2021
- PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473https://doi.org/10.7326/M18-0850
- Clinical quality registries: AIHW.2020 ([Available from:) (accessed 9th June 2021)
- Using Internet search engines to obtain medical information: a comparative study.J Med Internet Res. 2012; 14 ([published Online First: 2012/06/08]): e74https://doi.org/10.2196/jmir.1943
- Expert googling: best practices and advanced strategies for using Google in health sciences libraries.Med Ref Serv Q. 2006; 25 ([published Online First: 2006/06/20]): 97-107https://doi.org/10.1300/J115v25n02_08
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6 ([published Online First: 2009/07/22])e1000097https://doi.org/10.1371/journal.pmed.1000097
- Device-associated infection rates, bacterial resistance, length of stay, and mortality in Kuwait: international Nosocomial Infection Consortium findings.Am J Infect Control. 2016; 44: 444-449https://doi.org/10.1016/j.ajic.2015.10.031
- Multicenter study in Colombia: impact of a multidimensional International Nosocomial Infection Control Consortium (INICC) approach on central line–associated bloodstream infection rates.Am J Infect Control. 2016; 44: e235-e241https://doi.org/10.1016/j.ajic.2016.03.043
- Impact of a multidimensional international nosocomial infection control consortium (INICC) approach on ventilator-associated pneumonia rates and mortality in intensive care units in a Malaysian hospital.Can J Infect Control. 2016; 31: 230-236
- Monitoring quality of care through linkage of administrative data: national trends in bloodstream infection in U.K. PICUs 2003-2012.Crit Care Med. 2015; 43: 1070-1078https://doi.org/10.1097/CCM.0000000000000941
- Risk-adjusted monitoring of blood-stream infection in paediatric intensive care: a data linkage study.Intensive Care Med. 2013; 39: 1080-1087https://doi.org/10.1007/s00134-013-2841-z
- A multi-institutional registry of pediatric hospital-acquired thrombosis cases: the Children’s Hospital-Acquired Thrombosis (CHAT) project.Thromb Res. 2018; 161: 67-72https://doi.org/10.1016/j.thromres.2017.11.019
- Tracheal intubation practice and safety across international PICUs: a report from national emergency Airway registry for children.Pediatr Crit Care Med. 2019; 20: 1-8https://doi.org/10.1097/PCC.0000000000001782
- Device-associated infections rates in adult, pediatric, and neonatal intensive care units of hospitals in the Philippines: international Nosocomial Infection Control Consortium (INICC) findings.Am J Infect Control. 2011; 39 ([published Online First: 2011/05/28]): 548-554https://doi.org/10.1016/j.ajic.2010.10.018
- Site-level variance for adverse tracheal intubation-associated events across 15 north American PICUs: a report from the national emergency Airway registry for children.Pediatr Crit Care Med. 2014; 15: 306-313https://doi.org/10.1097/PCC.0000000000000120
- A national emergency Airway registry for children: landscape of tracheal intubation in 15 PICUs.Crit Care Med. 2013; 41: 874-885https://doi.org/10.1097/CCM.0b013e3182746736
- Device-associated infection rates in adult and pediatric intensive care units of hospitals in Egypt. International Nosocomial Infection Control Consortium (INICC) findings.Journal of infection and public health. 2012; 5 ([published Online First: 2013/01/05]): 394-402https://doi.org/10.1016/j.jiph.2012.07.002
- Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: international Nosocomial Infection Consortium findings.Pediatr Crit Care Med. 2012; 13: 399-406
- Findings of the international nosocomial infection control consortium (INICC), Part I: effectiveness of a multidimensional infection control approach on catheter-associated urinary tract infection rates in pediatric intensive care units of 6 developing countries.Infect Control Hosp Epidemiol. 2012; 33: 696-703
- Central and peripheral line-associated bloodstream infections in Australian neonatal and paediatric intensive care units: findings from a comprehensive Victorian surveillance network, 2008-2016.J Hosp Infect. 2018; 99: 55-61https://doi.org/10.1016/j.jhin.2017.11.021
- Device-associated infection and mortality rates, bacterial resistance, and length of stay in hospitals of Malaysia: international Nosocomial Infection Control Consortium (INICC)’s findings.Can J Infect Control. 2016; 31: 107-112
- Doing more of less: what registry data tell us about death in PICU.Intensive Care Med. 2019; 45: 1272-1274https://doi.org/10.1007/s00134-019-05714-x
- (Indian Registry of Intensive Care (IRIS Registry) [cited 7th June 2021]. Available from:)http://www.irisicuregistry.org/contact.htmlDate accessed: November , 2020
- No one is better than all together: the role of networks in pediatric intensive care.Rev Bras Ter Intensiva. 2019; 31 ([published Online First: 2019/10/17]): 277-281https://doi.org/10.5935/0103-507x.20190043
- Paediatric collaborative Latin American network LARed network, 2018 (LARed network). 2018 (Available from:)https://www.la-red.netDate accessed: October , 2020
- (National healthcare safety network (NHSN) [Available from:)https://www.cdc.gov/nhsn/datastat/index.htmlDate accessed: October , 2020
- Paediatric Intensive Care Evaluation (PICE). 2000 ([Available from:)http://www.pice.nl/Date accessed: October , 2020
- Pediatric Cardiac Critical Care Consortium (PC4). 2009 ([Available from:)https://pc4quality.org/Date accessed: October , 2020
- Paediatric intensive care database (PIC).2009 ([Available from:)http://pic.nbscn.org/Date accessed: October , 2020
- Sociedad Agentina de Terapia Argentina Quality (SATIQ). 1997 ([Available from:)http://pediatria.sati.org.ar/novedades.html(accessed)Date accessed: November , 2020
- Swedish intensive care register (SIR). 2001 ([cited 2021 August]. Available from:) (accessed June 2021)
- Central line associated bloodstream infections (CLABSI) report 2017/2018.2021 ([cited 2021 7th June]. Available from:)https://www.anzics.com.au/annual-reports/Date accessed: November , 2020
- Solutions for patient safety (SPS) national children's network.([Available from:)
Hospital BCs. International PICU Cloud: collaborative learning through outcomes data (PICU Cloud) [Available from: https://www.picucloud.org/accessed October 2020.
- ([cited 2021 August]. Available from:)
- International nosocomial infections Control contortium (INICC).2013 ([Available from:)http://www.inicc.org/system/Date accessed: November , 2020
- Central line associated bloodstream infections (CLABSI) report 2017/2018.
- Australian and New Zealand Pediatric Intensive Care Registry (ANZPIC-R): Australian and New Zealand Intensive Care Society. 1997 ([cited 2021 7th June ]. Available from:)
- Victorian healthcare associated infection surveillance system (VICNISS).Victorian State Government, 2002 ([Available from:)https://www.vicniss.org.auDate accessed: October , 2020
- The National Emergency Airway Registry for Kids (NEAR4KIDS).
- Second generation surveillance system (SGSS).
- Paediatric Intensive Care Audit network (PICANet).NHS England, 2002 ([Available from:)https://www.picanet.org.ukDate accessed: October , 2020
- National healthcare safety network (NHSN) reports.https://www.cdc.gov/nhsn/datastat/index.htmlDate accessed: October , 2020
- The epidemiology of health-care associated infections in pediatric cardiac intensive care units.Pediatr Infect Dis J. 2017; ([published Online First: 2017/12/28])https://doi.org/10.1097/inf.0000000000001884
- VPS PICU.
- International Nosocomial Infections Control Contortium (INICC).2013 ([Available from:)http://www.inicc.org/system/Date accessed: November , 2020
- Solutions for patient safety. For patients and families: children's hospitals' solutions for patient safety. 2021 ([Available from:)https://www.solutionsforpatientsafety.org/for-patients-families/Date accessed: September 27, 2021
- Second generation surveillance system (SGSS).([Available from:)
- Data collection tools.([Available from:)
- Enhance quality care performance: determination of the variables for establishing a common database in French paediatric critical care units.J Eval Clin Pract. 2018; 24: 767-771https://doi.org/10.1111/jep.12984
- Quality improvement studies in pediatric critical care medicine.Pediatr Crit Care Med. 2021; 22
- ACHS 2020 clinical indicator program information.in: Australian Council on Healthcare Standards (ACHS), NSW2020
- Defining and classifying clinical indicators for quality improvement.Int J Qual Health Care. 2003; 15: 523-530https://doi.org/10.1093/intqhc/mzg081
- Types of health care quality measures: AHRQ.2015 (Available from:)https://www.ahrq.gov/talkingquality/measures/types.htmlDate accessed: September 28, 2021
- Use of process measures to monitor the quality of clinical practice.BMJ. 2007; 335: 648-650https://doi.org/10.1136/bmj.39317.641296.AD
- Process versus outcome indicators in the assessment of quality of health care.Int J Qual Health Care. 2001; 13: 475-480https://doi.org/10.1093/intqhc/13.6.475
- Set of quality indicators of pediatric intensive care in Spain: Delphi method selection.Pediatr Qual Saf. 2017; 2 ([published Online First: 2017/01/16]): e009https://doi.org/10.1097/pq9.0000000000000009
- Process and outcome indicators for infection control and prevention in European acute care hospitals in 2011 to 2012 - results of the PROHIBIT study.Euro Surveill. 2018; 23 ([published Online First: 2018/05/31])https://doi.org/10.2807/1560-7917.Es.2018.23.21.1700513
- Surveillance for healthcare-associated infections: hospital-onset adult sepsis events versus current reportable conditions.Clin Infect Dis. 2021; ([published Online First: 2021/03/30])https://doi.org/10.1093/cid/ciab217
- Priorities for pediatric patient safety research.Pediatrics. 2019; 143e20180496https://doi.org/10.1542/peds.2018-0496
- Building a global, pediatric vascular access registry: a scoping review of trial outcomes and quality indicators to inform evidence-based practice.Worldviews Evid Based Nurs. 2019; 16: 51-59https://doi.org/10.1111/wvn.12339
- Quality and capacity indicators for hospitalized pediatric oncology patients with critical illness: a modified Delphi consensus.Cancer Med. 2020; 9 ([published Online First: 2020/08/11]): 6984-6995https://doi.org/10.1002/cam4.3351
- Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group.MMWR Recomm Rep (Morb Mortal Wkly Rep). 2001; 50 (quiz CE1-7. [published Online First: 2008/07/19]): 1-35
- A conceptual framework of data readiness: the contextual intersection of quality, availability, interoperability, and provenance.Appl Clin Inf. 2021; 12 ([published Online First: 2021/07/22]): 675-685https://doi.org/10.1055/s-0041-1732423
- Recommended practices for surveillance: association for professionals in infection control and epidemiology (APIC), Inc.Am J Infect Control. 2007; 35 ([published Online First: 2007/09/04]): 427-440https://doi.org/10.1016/j.ajic.2007.07.002
- The current scope of healthcare-associated infection surveillance activities in hospitalized immunocompromised patients: a systematic review.Int J Epidemiol. 2019; 48 ([published Online First: 2019/08/01]): 1768-1782https://doi.org/10.1093/ije/dyz162
- Classification performance of administrative coding data for detection of invasive fungal infection in pediatric cancer patients.PLoS One. 2020; 15 ([published Online First: 2020/09/10])e0238889https://doi.org/10.1371/journal.pone.0238889
- Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: experience from a low resource country.Pediatr Pulmonol. 2019; 54: 1234-1241https://doi.org/10.1002/ppul.24351
- From safety-I to safety-II: a white paper.University of Southern Denmark, University of Florida, and Macquarie University, Denmark, USA, Australia2015: 43
- Safety II behavior in a pediatric intensive care unit.Pediatrics. 2018; 141 ([published Online First: 2018/05/10])https://doi.org/10.1542/peds.2018-0018
- Measuring and improving the quality of NHS care for children and young people.Arch Dis Child. 2019; 104: 618https://doi.org/10.1136/archdischild-2017-314564
- Quality indicators: the use of metrics in critical care medicine.in: Hidalgo J. Pérez-Fernández J. Rodríguez-Vega G. Critical care administration. Springer, Cham, Switzerland AG2020: 69-81
- Natural language processing for the identification of surgical site infections in orthopaedics.J Bone Joint Surg Am. 2019; 101 ([published Online First: 2019/10/10]): 2167-2174https://doi.org/10.2106/jbjs.19.00661
- International recommendations for a vascular access minimum dataset: a Delphi consensus-building study.BMJ Qual Saf. 2021; 30: 722-730https://doi.org/10.1136/bmjqs-2020-011274
- Understanding consumer preference for vascular access safety and quality measurement: an international survey.Aust Health Rev. 2021; 46: 12-20https://doi.org/10.1071/AH21053
- Development of a paediatric central venous access device database: a retrospective cohort study of practice evolution and risk factors for device failure.J Paediatr Child Health. 2020; 56: 289-297https://doi.org/10.1111/jpc.14600
Article Info
Publication History
Published online: September 15, 2022
Accepted:
July 31,
2022
Received in revised form:
July 24,
2022
Received:
February 28,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
