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ObjectivesTo inform design of quality improvement tools specific to patients with prolonged intensive care unit stay, we determined characteristics (format/content), development, implementation and outcomes of published multi-component quality improvement tools used in the intenisve care unit irrespective of length of stay.Research MethodologyScoping review searching electronic databases, trial registries and grey literature (January 2000 to January 2022).ResultsWe screened 58,378 citations, identifying 96 studies. All tools were designed for use commencing at intensive care unit admission except three tools implemented at 3, 5 or 14 days. We identified 32 studies of locally developed checklists, 28 goal setting/structured communication templates, 23 care bundles and 9 studies of mixed format tools. Most (43 %) tools were designed for use during rounds, fewer tools were designed for use throughout the ICU day (27 %) or stay (9 %). Most studies (55 %) reported process objectives i.e., improving communication, care standardisation, or rounding efficiency. Most common clinical processes quality improvement tools were used to standardise were sedation (62, 65 %), ventilation and weaning (55, 57 %) and analgesia management (58, 60 %). 44 studies reported the effect of the tool on patient outcomes. Of these, only two identified a negative effect; increased length of stay and increased days with pain and delirium.ConclusionAlthough we identified numerous quality improvement tools for use in the intensive care unit, few were designed to specifically address actionable processes of care relevant to the unique needs of prolonged stay patients. Tools that address these needs are urgently required.

Patients with neuromuscular disorders often develop respiratory muscle weakness. These neuromuscular disorders include congenital diseases such as the muscular dystrophies, and non-congenital diseases such as multiple sclerosis, and amyotrophic lateral sclerosis. High spinal cord injuries can also result in respiratory muscle weakness. Irrespective of the cause, these patients experience weakened cough strength, impeding adequate secretion clearance and leading to increased risk of respiratory infection, a common cause of death. To reduce the risk of respiratory infection, patients with neuromuscular disorders are often supported with interventions to augment secretion clearance. Methods used to augment secretion clearance can be categorised into proximal (‘cough augmentation’) or distal techniques (‘sputum mobilisation’). Proximal techniques include assisted inspiration (e.g., intermittent positive pressure breathing, air stacking, glossopharyngeal breathing, lung volume recruitment), assisted expiration (e.g., manual assisted cough) and assisted inspiration and expiration (e.g., mechanical insufflation-exsufflation). Distal techniques include high frequency chest wall oscillation or compression, intrapulmonary percussive ventilation, and chest wall strapping. Use of secretion clearance techniques in patients with a neuromuscular disorder is varied in terms of choice of intervention, technique used, and availability of equipment between sites and countries. A frequently cited reason for this practice variation is the lack of evidence for the efficacy of these techniques or guidelines based on consensus opinion. Assessing the comparative efficacy of secretion clearance techniques is currently challenging due to the lack of a consensus in outcomes and measurement instruments. A key stakeholder informed core outcome set would assist with homogeneity in the outcomes reported in future trials. A core outcome set is an agreed set of outcomes which should be measured and reported when undertaking an investigation into a particular area. This set is agreed via a series of consensus building activities by a panel of experts including end users. As the first step to informing the development of a core outcome set, our objective is to conduct a scoping review to describe the outcomes reported in studies recruiting patients with neuromuscular disorders that result in respiratory weakness requiring airway clearance techniques. This core outcome set will inform studies of interventions to improve secretion clearance. Our secondary objectives are to describe (1) the instruments used to measure the outcomes identified; (2) the analysis metric used to evaluate the outcome (3); the method of aggregation for each outcome; and (4) the time horizon for measurement of each outcome. We have chosen a scoping review approach to chart outcomes and measures using various airway clearance techniques Scoping reviews are the advised methodology for this broad scope of work.

Additional file 1. PRISMA extension for scoping reviews checklist (PRISMA-scr).

Additional file 2. MEDLINE search strategy.