Patient Centered Quality Standards In Pediatric Critical Care: Opportunities And Obstacles

Abstract

Introduction: Providing medical care to a patient with latest gadgets and the most updated scientific knowledge is the most obvious practice in any pediatric intensive care unit. Quality indicators are crucial to measure various aspects of quality and patient safety in pediatric intensive care.

Aim: To assess the current status of patient centered quality standards in the four general PICUs of Cairo University specialized pediatric hospitals determining the opportunities and the obstacles for quality improvement.

Methods: Our study was a hospital based, quasi-experimental study that was conducted over a nine month period from April 2023 till end of December 2023, adopted baseline assessment, intervention and reassessment design, to evaluate the current status of patient centered quality standards, identifying priority areas, developing action plans to drive improvements in care quality and outcomes in the practice of paediatric critical care. It was conducted within the four general PICUs of Cairo University Specialized Pediatric Hospital. A preformed questionnaire was directed to the healthcare providers working at the four PICUs and interventions including health education and other tools were conducted.

Results: Structure quality indicators showed modest post-intervention improvement (change from 1.5% to 5.2%), while process indicators demonstrated substantial improvement (33.6%–35.1%). Mortality rates decreased from 8%–16.25% to 6.84%–11.74% (reduction: 27%–50.7%). Hand hygiene adherence improved among doctors (69.3% to 79.7%) and nurses (90.3% to 92.7%). Central line-associated bloodstream infection rates improved from 2.77–14.12 to 2.13–8.33 per 1,000 catheter-days (reduction: 23%–58.6%). Catheter-associated urinary tract infection rates changed from 6.47 to 5.39 per 1,000 urinary catheter-days. Length of stay, bed occupancy, and turnover rates showed variable responses across units.

Conclusions: Many of measured quality indicators as process, outcome and accountability indicators showed post-intervention improvement. Such interventions should be applied on a frequent, system embedded and sustainable basis.