What validated instruments, that measure implementation outcomes, are suitable for use in the Paediatric Intensive Care Unit (PICU) setting? A systematic review of systematic reviews

Background/Aims

The measurement of implementation outcomes can establish the success of implementingevidence into practice. However, implementation outcomes are seldom measured in acutehealthcare settings, such as Paediatric Intensive Care Units (PICU), and if they are used, arelikely to be non-validated, site or intervention-specific measures. To address this literaturegap, this systematic review of systematic reviews aims to identify validated instruments tomeasure implementation outcomes of new EBP interventions in a PICU setting.

Methods

A systematic review of systematic reviews was conducted in two phases. Phase One: Fiveelectronic databases were searched between 06/10/22 and 14/10/22. Systematic reviewswere selected using pre-determined eligibility criteria. Methodological quality was assessedusing the Critical Appraisal Skills Programme tool and a data extraction table was used toallow further synthesis. Phase Two: Secondary eligibility criteria were used to extract andreview instruments from the systematic reviews selected in Phase One. Instruments wereanalysed and mapped to the Consolidated Framework of Implementation Research (CFIR).

Results 

Phase One: Searches resulted in 3195 unique papers. Five systematic reviews were eligiblefor   inclusion.   All   examined   the   psychometric   properties   of   each   instrument,   utilisingdifferent methods to do so; three considered their pragmatic or usability properties; andone identified instruments that were transferrable to different settings. Each systematic review identified that most included instruments had limited evidence of their validity orreliability and had poor psychometric properties. Phase two: 93 instruments were screened,and nine were eligible for analysis. After analysis and CFIR mapping, two instruments wereidentified as potentially adaptable to the PICU setting.

Conclusions

The   methodological   quality   of   implementation   outcome   measurement   instruments   isinadequate, warranting further validation research. Two instruments were identified thatcover multiple CFIR domains and have scope to be adapted for use when implementingevidence-based practice into the PICU. Further work is needed to adapt and further validatean instrument for use in practice.

Registration

For transparency of procedures and methods, the protocol for this systematic review was registered with PROSPERO (registration number CRD42022361638L)