A mixed-method evaluation of the acceptability, appropriateness, and feasibility of using an actionable processes of care checklist for patients with persistent critical illness

Abstract<br/>Background: Patients with persistent critical illness have care priorities distinct from those experiencing acute critical illness. We developed a checklist called ‘Action 11’ incorporating actionable priorities of care for these patients.<br/>Objective: Evaluate the acceptability, appropriateness, and feasibility of using the Action 11 checklist.<br/><br/>Methods: Convergent mixed-method study in two units caring for patients with persistent critical illness (Unit 1 outside-; Unit 2 inside-critical care) of a community hospital in Canada. The checklist was used daily for four-weeks, then weekly for four-weeks. A sample of healthcare providers were recruited to evaluate checklist acceptability, appropriateness, and feasibility using a questionnaire and interviews.<br/><br/>Results: We received 52 questionnaires and conducted 14 interviews (August – November 2022). Of the 52 completed questionnaires, 35 (67%), 42 (81%), and 41 (79%) had a score of ≥ 16 for acceptability, appropriateness, and feasibility. Of a maximum score of 20, the total mean (SD) scores for acceptability, appropriateness, and feasibility were 16.2 (2.9), 16.7 (2.4) and 17 (2.5), respectively. <br/>Participants from Unit 1 found the checklist more acceptable (mean difference 1.7 [0.2 – 3.29], 95% CI) and feasible (mean difference 1.46 [0.09 – 2.84], 95% CI) to use than those from Unit 2. Qualitative descriptions for acceptability (comprehensive, inclusive, straightforward, prevented omissions in care, and promoted professional accountability), appropriateness (suited patient needs and enabled a personalized, consistent and collaborative approach to care), and feasibility (embedding into existing rounding, tailored to unit processes, and through leadership support) were also positive, however, they did not explain differences in rated acceptability and feasibility between the two units.<br/><br/>Conclusions: The Action 11 checklist was perceived as acceptable, appropriate, and feasible to use in units caring for patients with persistent critical illness. Larger-scale evaluation the of the Action11 checklist exploring its effect on care processes and patient outcomes is recommended.<br/>