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：在非洲医院为危重儿童提供及时且高质量的初始诊疗服务仍是一项难题。监测复苏（resuscitation）过程中关键操作的完成情况，有助于减少诊疗差异、改善临床结局。本研究旨在通过德尔菲法（Delphi process）筛选符合当地场景的关键操作，开发一款基于临床实践的工具，以识别诊疗缺口、辅助制定培训方案与标准化评估流程，进而支撑医疗质量改善工作。 研究设计：基于非洲城乡急诊科的疾病流行病学特征与死亡率数据，筛选出6种哨兵病种（sentinel conditions）。通过针对性文献综述确定潜在关键操作，随后采用三轮改良德尔菲法对这些操作进行评估，并对候选操作列表应用一系列逻辑筛选标准，最终生成基于临床实践的工具。 研究场景与研究对象：本次研究的专家委员会由25名国际急诊医学会议的与会者组成，其中84%的专家主要在非洲地区开展临床工作。共识征集环节支持专家提出新观点，通过线上与线下问卷完成三轮共识调研。 研究结果：专家委员会共梳理出适用于6种儿童急诊重症情况的199项关键操作。经适用性标准筛选后，最终得到涵盖7大类的92项候选操作，分别为：核心技能、活动性癫痫发作、意识状态改变、腹泻性疾病、发热性疾病、呼吸窘迫与多发伤。在此基础上，我们筛选出28项操作纳入本临床实践工具，这些操作均贴合非洲危重儿童初始诊疗的场景需求。 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护理中，针对特定哨兵病种的危重儿童所需的关键操作。若复苏过程中缺失这些操作，可能反映出医疗质量中可优化的缺口。最终生成的这款临床实践工具贴合当地场景，可作为非洲医院与急诊科开展培训及医疗质量改善工作的基础框架。