Kourtis Susan A, Burns Jeffrey P
Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital.
Department of Anesthesia Harvard Medical School Boston Massachusetts USA.
Pediatr Investig. 2019 Jun 25;3(2):110-116. doi: 10.1002/ped4.12133. eCollection 2019 Jun.
Measuring and improving performance is an essential component of any high-risk industry, including intensive care medicine. We undertook this systematic review to describe the current state of quality improvement efforts in pediatric intensive care medicine.
To evaluate the quality and rigor of all published literature on quality improvement efforts in the pediatric intensive care unit in the current era.
We conducted a literature search on MEDLINE, Embase, and Cochrane for studies that met two broad inclusion criteria: 1) the terms "pediatric critical care" and "quality improvement" and 2) they were completed in the past ten years. In the initial search, we also included academic and professional societies or organizations devoted to providing resources on quality improvement in intensive care medicine. We excluded studies that examined quality improvement processes exclusively for neonatal or adult patients receiving intensive care.
Forty-nine of 332 identified articles were selected for final review by two reviewers who independently rated the quality of the methodology and rigor of the evidence reported for each study. Of these, 23 studies targeted structural issues, 14 studies targeted process issues, and 12 targeted an outcome as the focus of the intensive care quality improvement effort.
Our review of the published literature on quality improvement efforts in the pediatric intensive care unit in the current era found that 85% of studies were limited in methodology or analysis. Fifteen high-quality studies are reported here and serve as helpful examples of rigorous research methodology in this domain going forward.
衡量和提升绩效是包括重症监护医学在内的任何高风险行业的重要组成部分。我们进行了这项系统评价，以描述儿科重症监护医学质量改进工作的现状。
评估当前时代所有已发表的关于儿科重症监护病房质量改进工作的文献的质量和严谨性。
我们在MEDLINE、Embase和Cochrane上进行了文献检索，以查找符合两个广泛纳入标准的研究：1）“儿科重症监护”和“质量改进”这两个术语；2）它们是在过去十年内完成的。在初步检索中，我们还纳入了致力于提供重症监护医学质量改进资源的学术和专业协会或组织。我们排除了专门研究接受重症监护的新生儿或成人患者质量改进过程的研究。
332篇已识别文章中的49篇由两名评审员挑选出来进行最终评审，这两名评审员独立对每项研究报告的方法质量和证据严谨性进行评分。其中，23项研究针对结构问题，1项研究针对过程问题，12项研究将结果作为重症监护质量改进工作的重点。
我们对当前时代已发表的关于儿科重症监护病房质量改进工作的文献进行的综述发现，85%的研究在方法或分析上存在局限性。本文报告了15项高质量研究，这些研究可作为该领域未来严谨研究方法的有益示例。
