Abstract
BackgroundIncreasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families and cost to health systems. Quality improvement tools such as checklists concisely articulate best practices with the aim of improving quality and safety; however, these tools have not been designed for the specific needs of patients with prolonged ICU stay.The primary objective of this review will be to determine the characteristics including format and content of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to describe the outcomes reported in these tools, the type of patients and settings studied, and to understand how these tools were developed and implemented in clinical practice.MethodsWe will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards. We will include primary research studies (e.g. experimental, quasi-experimental, observational and qualitative studies) recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement tools such as structured care plans or checklists designed to standardize more than one aspect of care delivery. We will extract data on study and patient characteristics, tool design and implementation strategies and measured outcomes. Two reviewers will independently screen citations for eligible studies and perform data extraction. Data will be synthesised with descriptive statistics; we will use a narrative synthesis to describe review findings.DiscussionThe findings will be used to guide development of tools for use with prolonged ICU stay patients. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools these patients. Such tools are needed to standardise practice and thereby improve quality of care. Illustrating the development and implementation methods used for such tools will help to guide translation of similar tools into ICU clinical practice and future research.Systematic review registrationThis protocol is registered on the Open Science Framework, https://osf.io/, DOI https://doi.org/10.17605/OSF.IO/Z8MRE
Highlights
MethodsWe will search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINA HL), EMBASE, MEDLINE, PsycINFO, Web of Science, OpenGrey, NHS evidence and Trial Registries from January 2000 onwards
Increasing numbers of critically ill patients experience a prolonged intensive care unit stay contributing to greater physical and psychological morbidity, strain on families and cost to health systems
Increasing numbers of patients remain in intensive care units (ICUs) for longer than a week due to increased survival rates, comorbidity and age in the general population resulting in lower resilience to acute illness and longer recovery [1,2,3,4]
Summary
The present protocol has been registered within the Open Science Framework platform (https://osf.io/ z8mre). We will exclude checklists for procedures such as central line insertion or tools such as care bundles with single objectives of care, e.g. to prevent ventilator-associated pneumonia Protocols, including those for delirium prevention, sedation management, weaning, and mobilisation will be excluded as we do not seek to produce a decision algorithm and this format is outside the scope of this review. Single objective protocols, including those for delirium prevention, sedation management, weaning, and mobilisation will be excluded as we do not seek to produce a decision algorithm and this format is outside the scope of this review.
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