背景:在成人重症监护病房(ICU)中指导干预措施以提高成本效益的证据有限。本共识声明的目的是确定全球适用的干预措施,以实现ICU的最佳实践,并为合理使用资源提供指导。
方法:三轮修改的在线Delphi过程,使用基于Web的平台,寻求61名多学科ICU专家的共识(医师,护士,联合健康,管理员)来自21个国家。第1轮是定性的,以确定基于高价值医疗保健的四个关键领域(基本要素;基础设施基础;护理提供优先级;可靠性和反馈)的成本效益标准的意见。第二轮是定性和定量的,而第三轮是定量的,以重申和建立标准。第2轮和第3轮都使用了5分的李克特量表进行投票。当超过70%的专家投票赞成拟议的干预措施时,就考虑了共识。此后,指导委员会认可了50%以上指导委员会成员认定为“关键”的干预措施。这些干预措施和专家意见被总结为最佳实践的最终考虑因素。
结果:在第3轮结束时,就成人ICU的成本效益50个最佳实践考虑因素达成了共识。最后,指导委员会认可了9个“关键”最佳实践考虑因素。这包括采用多学科ICU护理模式,注重员工培训和能力评估,正在进行的质量审核,从而确保高质量的重症监护服务,无论是在重症监护病房的四面墙内还是外,实施动态员工名册,实施临终关怀的多学科方法,尽早动员和促进关于绿色ICU概念的国际共识努力。
结论:这项与国际专家进行的Delphi研究得出了9项共识声明和最佳实践考虑因素,以促进成人ICU的成本效益。利益相关者(政府机构,专业协会)必须领导努力确定当地适用的细节,同时利用可用资源在这些最佳实践考虑范围内工作。
There is limited evidence to guide interventions that promote cost-effectiveness in adult intensive care units (ICU). The aim of this
consensus statement is to identify globally applicable interventions for best ICU practice and provide guidance for judicious use of resources.
A three-round modified online Delphi process, using a web-based platform, sought
consensus from 61 multidisciplinary ICU experts (physicians, nurses, allied health, administrators) from 21 countries. Round 1 was qualitative to ascertain opinions on cost-effectiveness criteria based on four key domains of high-value healthcare (foundational elements; infrastructure fundamentals; care delivery priorities; reliability and feedback). Round 2 was qualitative and quantitative, while round 3 was quantitative to reiterate and establish criteria. Both rounds 2 and 3 utilized a five-point Likert scale for voting.
Consensus was considered when > 70% of the experts voted for a proposed intervention. Thereafter, the steering committee endorsed interventions that were identified as \'critical\' by more than 50% of steering committee members. These interventions and experts\' comments were summarized as final considerations for best practice.
At the conclusion of round 3,
consensus was obtained on 50 best practice considerations for cost-effectiveness in adult ICU. Finally, the steering committee endorsed 9 \'critical\' best practice considerations. This included adoption of a multidisciplinary ICU model of care, focus on staff training and competency assessment, ongoing quality audits, thus ensuring high quality of critical care services whether within or outside the four walls of ICUs, implementation of a dynamic staff roster, multidisciplinary approach to implementing end-of-life care, early mobilization and promoting international consensus efforts on the Green ICU concept.
This Delphi study with international experts resulted in 9
consensus statements and best practice considerations promoting cost-effectiveness in adult ICUs. Stakeholders (government bodies, professional societies) must lead the efforts to identify locally applicable specifics while working within these best practice considerations with the available resources.