Standardising Care in the ICU: A Protocol for a Scoping Review of Tools used to Improve Care Delivery

Abstract

Background: 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. Healthcare providers report dissatisfaction with provision of care for these longer stay patients due to competing demands from higher acuity patients. 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 objective of this review is to generate data to inform development and implementation of quality improvement tools for patients with prolonged ICU stay, namely: the content, design and effect of multicomponent tools designed to standardise or improve ICU care. Secondary objectives are to understand how these tools were developed and implemented in clinical practice.Methods: We 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 1999 to August 2019. We will include primary research studies recruiting more than 10 adult participants admitted to ICUs, high dependency units and weaning centres regardless of length of stay, describing quality improvement measures such as structured care plans or checklists designed to standardize more than one aspect of care delivery. Two authors will independently screen citations for eligible studies and perform data extraction. We will use a narrative synthesis to describe review findings.Discussion: The findings will be used to guide development of tools for use with prolonged ICU stay. Our group will use experience-based co-design methods to identify the most important actionable processes of care to include in quality improvement tools for patients with prolonged ICU stay. Such tools are needed to standardise practice and thereby improve quality of care for patients with prolonged ICU stay and their families. Illustrating the development and implementation methods used for such tools will help to guide translation for similar tools in ICU and future research.Systematic Review Registration: This protocol is registered on the Open Science Framework, https://osf.io/ , DOI 10.17605/OSF.IO/Z8MRE