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.
2-040 Li Ka Shing Center for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1, Canada.
J Crit Care. 2018 Oct;47:145-152. doi: 10.1016/j.jcrc.2018.06.023. Epub 2018 Jun 30.
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.
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.
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.
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.
连续肾脏替代疗法（CRRT）是一种复杂的维持生命的治疗方法，仅用于病情最危急的患者，且应安全、一致、高质量地进行。然而，目前缺乏针对 CRRT 护理的有效循证质量指标（QIs）。本研究旨在确定 CRRT 护理的优先 QIs 列表，以便在任何 CRRT 项目中使用。
我们采用改良的三阶段 Delphi 法。这包括两轮基于网络的投票和一轮现场会议。我们招募了一个多学科的重症肾脏科专家和知识使用者小组。在 Delphi 过程的每个阶段，小组成员都要回答一个 QI 是否应包含在最终列表中。在第三轮中，对任何存在纳入不确定性的 QI 进行讨论，并对是否纳入做出最终决定。
共有 41 名小组成员（18 名来自肾脏病学，11 名来自重症监护，7 名教育者，2 名决策者，2 名行业代表和 1 名药剂师）来自北美、欧洲、澳大拉西亚和南美洲。经过第三轮 Delphi 投票，确定了 13 项 CRRT 护理质量指标；其中 10 项 QI 的正面有效性得到了高度一致的认可，而 3 项 QI 的正面有效性则得到了中等程度的认可。
我们制定了 CRRT 护理的优先 13 项 QIs 列表。未来的工作应集中于为这些 QIs 制定经过验证的基准，并将其纳入 CRRT 项目中。
