A Delphi Study to identify and prioritise low value care practices in UK PICUs for de-implementation

Paediatric Critical Care is an essential, but high-cost specialty. North American work, reflected in the ‘Choosing Wisely’ campaign has demonstrated that intensive care units are rife in undertaking many unnecessary practices, tests and procedures [1-3]. The same is true for paediatrics [4-5] This is due in part to a lack of evidence to support many practices, a perceived risk and fear of not doing something and the ease of being able to do things. These are termed low value care (LVC) practices [1] and are defined as clinical practices that are unnecessary or potentially harmful and expose patients to avoidable risks of harm or are ineffective and incongruent with efforts to improve care. There are three categories of LVC: those where the best available evidence suggests that there is (1) little to no benefit for patients (ineffective), (2) the benefits provided are not proportional to the cost (inefficient) or (3) the risk of harm exceeds the potential benefit (unsafe). These practices are unhelpful to patients, financially and environmentally wasteful, and unnecessarily increase staff workload, already identified to be high.
Increasingly it is being recognised that ‘doing less is probably doing more’ in terms of patient benefit. Although adult critical care in the US and Canada has identified priority areas for de-implementation, no such exercise has been undertaken in the UK and no one ever in Paediatric critical care. We believe a formal Delphi study should be conducted to identify the LVC priorities for de-implementation across UK PCCUs. This would serve two aims, 1) to gain a consensus top 5 practices for PICUs to stop in the next 2-5 years and 2) to identify practices that require robust research evidence to stop and prioritise these going forward.