Data from: Development of a simple, practice-based tool to assess quality of paediatric emergency care delivery in resource-limited settings: identifying critical actions via a Delphi study

Objective: Provision of timely, high-quality care for the initial management of critically ill children in African hospitals remains a challenge. Monitoring the completion of critical actions during resuscitations can inform efforts to reduce variability and improve outcomes. We sought to develop a practice-based tool based on contextually relevant actions identified via a Delphi process. Our goal was to develop a tool that could identify gaps in care, facilitate identification of training and standardized assessment to support quality improvement efforts. Design: Six sentinel conditions were selected based on disease epidemiology and mortality at rural and urban African emergency departments. Potential critical actions were identified through focused literature review. These actions were evaluated within a three-round modified Delphi process. A set of logistical filters was applied to the candidate list to derive a practice-based tool. Setting and participants: Attendees at an international emergency medicine conference comprised an expert panel of 25 participants, with 84% working primarily in African settings. Consensus rounds allowing novel responses were conducted via online and in-person surveys. Results: The expert panel generated 199 actions that apply to six conditions in emergently ill children. Application of appropriateness criteria refined this to 92 candidate actions across seven categories: core skills, active seizure, altered mental status, diarrheal illness, febrile illness, respiratory distress, polytrauma. From these, we identified 28 actions for inclusion in a practice-based tool contextually relevant to the initial management of critically ill children in Africa. Conclusions: A group consensus process identified critical actions for severely ill children with select sentinel conditions in emergency paediatric care in an African setting. Absence of these actions during resuscitation might reflect modifiable gaps in quality of care. The resulting practice-based tool is context-relevant and can serve as a foundation for training and quality improvement efforts in African hospitals and emergency departments.

研究目标：针对非洲医院内危重儿童的初始救治，提供及时且高质量的医疗服务仍是一项挑战。监测复苏救治过程中关键操作的完成情况，可为降低救治差异、改善临床结局提供优化方向。本研究旨在基于德尔菲法（Delphi Process）筛选出符合场景需求的关键操作，开发一款临床实践工具。该工具的核心目标为识别医疗照护中的短板，助力明确培训需求与标准化评估方案，以支撑质量改进工作。
研究设计：本研究基于非洲城乡急诊科室的疾病流行病学特征与病死率，筛选出6种哨兵病种。通过针对性文献综述确定潜在关键操作，并经三轮改良德尔菲法对上述操作进行评估。随后对候选操作清单应用一系列实操性筛选规则，最终生成符合临床实践需求的工具。
研究场景与研究对象：本研究的专家委员会由25名国际急诊医学大会参会者组成，其中84%的专家主要在非洲地区开展工作。允许提交新增意见的共识征集轮次通过线上与线下问卷的形式完成。
研究结果：专家委员会共梳理出适用于6种急诊危重儿童病种的199项关键操作。经适宜性标准筛选后，最终得到7大类共92项候选操作，分别为：核心技能、活动性癫痫、意识状态改变、腹泻性疾病、发热性疾病、呼吸窘迫与多发伤。最终从中筛选出28项操作纳入本临床实践工具，该工具与非洲地区危重儿童的初始救治场景高度适配。
研究结论：通过群体共识流程，本研究明确了非洲地区急诊儿科诊疗中，针对特定哨兵病种的危重儿童所需的关键操作。复苏救治过程中若缺失上述操作，可能反映出医疗质量中可被改进的短板。本研究开发的临床实践工具贴合当地场景，可作为非洲医院与急诊科室开展培训与质量改进工作的基础框架。