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J Crit Care. 2018 Oct;47:145-152. doi: 10.1016/j.jcrc.2018.06.023. Epub 2018 Jun 30.

A modified Delphi process to identify, rank and prioritize quality indicators for continuous renal replacement therapy (CRRT) care in critically ill patients.

Author information

1
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta T6G 2B7, Canada. Electronic address: rewa@ualberta.ca.
2
2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1, Canada. Electronic address: deurich@ualberta.ca.
3
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta T6G 2B7, Canada. Electronic address: ngibney@ualberta.ca.
4
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St. NW, Critical Care Medicine 2-124E Clinical Sciences Building, Edmonton, Alberta T6G 2B7, Canada. Electronic address: bagshaw@ualberta.ca.

Abstract

BACKGROUND:

Continuous renal replacement therapy (CRRT) is a complex and life-sustaining therapy, reserved for our most acutely ill patients, and should be delivered in a safe, consistent and high-quality manner. However valid evidence-based quality indicators (QIs) for CRRT care are lacking. The objective of this study was to develop a prioritized list of QIs for CRRT care that may be used in any CRRT program.

METHOD:

We conducted a modified three stage Delphi process. This consisted of two web-based rounds followed by an in-person meeting. We recruited an interdisciplinary panel of critical care nephrology experts and knowledge users. In each stage of the Delphi process panelists responded on whether a QI should be included in our final list. In the third round, any QI for which there was uncertainty to include was discussed and a final decision on whether to include was made.

RESULTS:

Forty-one panelists participated (18 from nephrology, 11 from intensive care, 7 educators, 2 decision-makers, 2 industry representatives and 1 pharmacist) from North America, Europe, Australasia and South America. Following the third Delphi round, 13 QIs for CRRT care were identified; 10 QIs were identified with a high level of agreement for face validity while 3 QIs were identified with a moderate level of agreement for face validity among panelists.

CONCLUSIONS:

We developed a prioritized list of 13 QIs for CRRT care. Future work should focus on developing validated benchmarks for these QIs and implementing them into CRRT programs.

KEYWORDS:

Continuous quality improvement; Critical care; Health services research; Healthcare quality improvement; Performance measures

PMID:
29990792
DOI:
10.1016/j.jcrc.2018.06.023

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