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. 2017 Dec;20(6):1367-1374.
doi: 10.1111/hex.12576. Epub 2017 May 31.

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making

Emily McKenzie  1 , Melissa L Potestio  1   2 , Jamie M Boyd  2   3   4 , Daniel J Niven  1   2   3 , Rebecca Brundin-Mather  4 , Sean M Bagshaw  5 , Henry T Stelfox  1   2   3 ; Improving Daily Care in the ICU Panel
Collaborators, Affiliations

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making

Emily McKenzie et al. Health Expect. 2017 Dec.

Abstract

Background: Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations.

Objective: To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list.

Design: We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus.

Setting and participants: Nine panellists including three providers, three decision makers and three family members of previously critically ill patients.

Results: Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion.

Conclusions: Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups.

Keywords: consensus; critical care; health priorities; intensive care; intensive care unit; patient participation; qualitative research; quality improvement; surveys and questionnaires.

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Figures

Figure 1
Figure 1
Flow of priorities through prioritization rounds
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References

    1. World Health Organization . Patient safety. 2015. http://www.who.int/patientsafety/about/en/. Accessed October 5, 2015.
    1. Institute of Medicine Committee on the Quality of Health Care in America . Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
    1. Institute of Medicine . To Err is Human: Building a Safer Health System. Washington, DC: Institute of Medicine‐Committee on Quality of Health Care in America; 1999.
    1. Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW. The “To Err is Human” report and the patient safety literature. Qual Saf Health Care. 2006;15:174‐178. - PMC - PubMed
    1. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324:370‐376. - PubMed

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