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：在非洲医院为危重症儿童提供及时、高质量的初始诊疗服务仍是一项挑战。对复苏过程中关键操作的完成情况进行监测，可为降低诊疗差异、改善预后提供依据。本研究旨在通过德尔菲（Delphi）法筛选符合场景需求的关键操作，开发一款基于临床实践的工具；其核心目标为识别诊疗环节中的短板，助力培训与标准化评估工作开展，以支撑质量改进项目的推进。

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种哨兵疾病（sentinel conditions）。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这些操作进行评估；随后对候选操作清单施加一系列逻辑筛选条件，最终形成基于临床实践的工具。

研究场景与研究对象：本次研究的专家小组由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。允许提出新增备选意见的共识调研环节，通过线上与线下问卷的形式完成。

研究结果：专家小组共整理出适用于6种儿童急重症的199项关键操作；经适宜性标准筛选后，该清单被精简为涵盖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、多发伤。基于此，最终筛选出28项操作纳入本研究的临床实践工具，该工具与非洲危重症儿童的初始诊疗场景高度适配。

研究结论：通过群体共识调研流程，本研究明确了非洲地区急诊儿科诊疗中，针对选定哨兵疾病的危重症儿童所需的关键操作。复苏过程中此类操作的缺失，可反映出诊疗质量中可被改进的短板。最终形成的这款临床实践工具具备场景适配性，可作为非洲医院与急诊科开展培训及质量改进工作的基础框架。