Quality indicators for high acuity pediatric conditions.
OBJECTIVE
Identifying gaps in care and improving outcomes for severely ill children requires the development of evidence-based performance measures. We used a systematic process involving multiple stakeholders to identify and develop evidence-based quality indicators for high acuity pediatric conditions relevant to any emergency department (ED) setting where children are seen.


METHODS
A prioritized list of clinical conditions was selected by an advisory panel. A systematic review of the literature was conducted to identify existing indicators, as well as guidelines and evidence that could be used to inform the creation of new indicators. A multiphase, Rand-modified Delphi method consisting of anonymous questionnaires and a face-to-face meeting of an expert panel was used for indicator selection. Measure specifications and evidence grading were created for each indicator, and the feasibility and reliability of measurement was assessed in a tertiary care pediatric ED.


RESULTS
The conditions selected for indicator development were diabetic ketoacidosis, status asthmaticus, anaphylaxis, status epilepticus, severe head injury, and sepsis. The majority of the 62 selected indicators reflect ED processes (84%) with few indicators reflecting structures (11%) or outcomes (5%). Thirty-seven percent (n = 23) of the selected indicators are based on moderate or high quality evidence. Data were available and interrater reliability acceptable for the majority of indicators.


CONCLUSIONS
A systematic process involving multiple stakeholders was used to develop evidence-based quality indicators for high acuity pediatric conditions. Future work will test the reliability and feasibility of data collection on these indicators across the spectrum of ED settings that provide care for children.
MDCM, MBA, MSc, Alberta Children's Hospital, 2888 Shaganappi Trail, Calgary AB, T3B 6A8. antonia.stang@albertahealthservices.ca.
Antonia S
AS
Stang
Sharon E
SE
Straus
Jennifer
J
Crotts
David W
DW
Johnson
Astrid
A
Guttmann
D002648:Child; D005240:Feasibility Studies; D006801:Humans; D062072:Patient Acuity; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*
emergency department; performance measurement; quality improvement; quality indicators