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Interventions for improving critical care in low- and middle-income countries: a systematic review

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Abstract

Purpose

To systematically review the typology, impact, quality of evidence, barriers, and facilitators to implementation of Quality Improvement (QI) interventions for adult critical care in low- and middle-income countries (LMICs).

Methods

MEDLINE, EMBASE, Cochrane Library and ClinicalTrials.gov were searched on 1st September 2022. The studies were included if they described the implementation of QI interventions for adult critical care in LMICs, available as full text, in English and published after 2000. The risks of bias were assessed using the ROB 2.0/ROBINS-I tools. Intervention strategies were categorised according to a Knowledge Translation framework. Interventions’ effectiveness were synthesised by vote counting and assessed with a binomial test. Barriers and facilitators to implementation were narratively synthesised using the Consolidated Framework for Implementation Research.

Results

78 studies were included. Risk of bias was high. The most common intervention strategies were Education, Audit & Feedback (A&F) and Protocols/Guidelines/Bundles/Checklists (PGBC). Two multifaceted strategies improved both process and outcome measures: Education and A&F (p = 0.008); and PGBC with Education and A&F (p = 0.001, p < 0.001). Facilitators to implementation were stakeholder engagement, organisational readiness for implementation, and adaptability of interventions. Barriers were lack of resources and incompatibility with clinical workflows.

Conclusions

The evidence for QI in critical care in LMICs is sparse and at high risk of bias but suggests that multifaceted interventions are most effective. Co-designing interventions with and engaging stakeholders, communicating relative advantages, employing local champions and adapting to feedback can improve implementation. Hybrid study designs, process evaluations and adherence to reporting guidelines would improve the evidence base.

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Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

References

  1. McPheeters ML, Kripalani S, Peterson NB, Idowu RT, Jerome RN, Potter SA, Andrews JC, (2012) Closing the quality gap: revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities). Evid Rep Technol Assess (Full Rep): 1–475. https://www.ncbi.nlm.nih.gov/books/NBK107315/

  2. Jones B, Kwong E, Warburton W (2021) Quality improvement made simple: What everyone should know about Healthcare quality improvement: Quick guide. Health Foundation, https://www.health.org.uk/sites/default/files/upload/publications/2021/QualityImprovementMadeSimple.pdf. Accessed April 2021

  3. Coles E, Anderson J, Maxwell M, Harris FM, Gray NM, Milner G, MacGillivray S (2020) The influence of contextual factors on healthcare quality improvement initiatives: a realist review. Syst Rev 9:1–22. https://doi.org/10.1186/s13643-020-01344-3

    Article  Google Scholar 

  4. Baelani I, Jochberger S, Laimer T, Otieno D, Kabutu J, Wilson I, Baker T, Dünser MW (2011) Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers. Crit Care 15:1–12. https://doi.org/10.1186/cc9410

    Article  Google Scholar 

  5. Losonczy LI, Papali A, Kivlehan S, Hynes EJC, Calderon G, Laytin A, Moll V, Al Hazmi A, Alsabri M, Aryal D (2021) White paper on early critical care services in low resource settings. Ann Glob Health. https://doi.org/10.5334/2Faogh.3377

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dünser MW, Baelani I, Ganbold L (2006) A review and analysis of intensive care medicine in the least developed countries. Crit Care Med 34:1234–1242. https://doi.org/10.1097/01.ccm.0000208360.70835.87

    Article  PubMed  Google Scholar 

  7. Morton B, Stolbrink M, Kagima W, Rylance J, Mortimer K (2018) The early recognition and management of sepsis in Sub-Saharan African adults: a systematic review and meta-analysis. Int J Environ Res Public Health 15:2017. https://doi.org/10.3390/2Fijerph15092017

    Article  PubMed  PubMed Central  Google Scholar 

  8. Brima N, Morhason-Bello IO, Charles V, Davies J, Leather AJ (2022) Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions. BMJ Open 12:e062616. https://doi.org/10.1136/bmjopen-2022-062616

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ridde V (2016) Need for more and better implementation science in global health. BMJ Glob Health 1:e000115. https://doi.org/10.1136/bmjgh-2016-000115

    Article  PubMed  PubMed Central  Google Scholar 

  10. The Lancet Global H (2023) Implementing implementation science in global health. Lancet Glob Health 11:e1827. https://doi.org/10.1016/s2214-109x(23)00523-5

    Article  CAS  Google Scholar 

  11. Proctor EK, Bunger AC, Lengnick-Hall R, Gerke DR, Martin JK, Phillips RJ, Swanson JC (2023) Ten years of implementation outcomes research: a scoping review. Implement Sci 18:31. https://doi.org/10.1186/s13012-023-01286-z

    Article  PubMed  PubMed Central  Google Scholar 

  12. Vincent J-L, Marshall JC, Ñamendys-Silva SA, François B, Martin-Loeches I, Lipman J, Reinhart K, Antonelli M, Pickkers P, Njimi H (2014) Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med 2:380–386. https://doi.org/10.1016/S2213-2600(14)70061-X

    Article  PubMed  Google Scholar 

  13. Vukoja M, Riviello E, Gavrilovic S, Adhikari NK, Kashyap R, Bhagwanjee S, Gajic O, Kilickaya O, Investigators C (2014) A survey on critical care resources and practices in low-and middle-income countries. Glob Heart 9(337–342):e335. https://doi.org/10.1016/j.gheart.2014.08.002

    Article  Google Scholar 

  14. Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, Gordon SB, Hamilton DO, Huluka DK, Khalid K, Lakoh S, Limbani F, Rylance J, Sawe HR, Simiyu I, Waweru-Siika W, Worrall E, Morton B (2023) A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med 49:772–784. https://doi.org/10.1007/2Fs00134-023-07136-2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Beane A, Salluh JIF, Haniffa R (2021) What intensive care registries can teach us about outcomes. Curr Opin Crit Care 27:537–543. https://doi.org/10.1097/2FMCC.0000000000000865

    Article  PubMed  PubMed Central  Google Scholar 

  16. Biccard BM, Gopalan PD, Miller M, Michell WL, Thomson D, Ademuyiwa A, Aniteye E, Calligaro G, Chaibou MS, Dhufera HT (2021) Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study. The Lancet 397:1885–1894. https://doi.org/10.1016/s0140-6736(21)00441-4

    Article  CAS  Google Scholar 

  17. Centre for reviews and dissemination UoY (2022) PROSPERO International prospective register of systematic reviews In: Editor (ed)^(eds) Book PROSPERO International prospective register of systematic reviews City, pp. https://www.crd.york.ac.uk/prospero/#guidancenotes

  18. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906. https://doi.org/10.1136/bmj.n71

    Article  PubMed  Google Scholar 

  19. Hamadeh N, Van Rompaey C, Metreau E, Eapen SG (2022) New World Bank country classifications by income level: 2022–2023. World Bank Blogs 1. https://blogs.worldbank.org/opendata/new-world-bank-country-classifications-income-level-2022-2023. Accessed 01 July 2022

  20. Society IC (2021) Levels of Adult Critical Care Second Edition Consensus Statement. In: Book Levels of Adult Critical Care Second Edition Consensus Statement. https://www.cc3n.org.uk/uploads/9/8/4/2/98425184/2021-03__levels_of_care_second_edition.pdf. Accessed March 2021

  21. Allum L, Apps C, Hart N, Pattison N, Connolly B, Rose L (2020) Standardising care in the ICU: a protocol for a scoping review of tools used to improve care delivery. Syst Rev 9:164. https://doi.org/10.1186/s13643-020-01414-6

    Article  PubMed  PubMed Central  Google Scholar 

  22. Covidence (2020) Better systematic review management. In: Book Better systematic review management https://www.covidence.org/

  23. Excellence N-NIfHaC (2012) Appendix D Glossary of study designs. In: Book Appendix D Glossary of study designs. https://www.nice.org.uk/process/pmg4/chapter/appendix-d-glossary-of-study-designs. Accessed 26 Sept 2012.

  24. Sinuff T, Muscedere J, Adhikari NK, Stelfox HT, Dodek P, Heyland DK, Rubenfeld GD, Cook DJ, Pinto R, Manoharan V, Currie J, Cahill N, Friedrich JO, Amaral A, Piquette D, Scales DC, Dhanani S, Garland A (2013) Knowledge translation interventions for critically ill patients: a systematic review. Crit Care Med 41:2627–2640. https://doi.org/10.1097/CCM.0b013e3182982b03

    Article  PubMed  Google Scholar 

  25. Gough D (2007) Weight of evidence: a framework for the appraisal of the quality and relevance of evidence. Res Pap Educ 22:213–228. https://doi.org/10.1080/02671520701296189

    Article  Google Scholar 

  26. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan A-W, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  PubMed Central  Google Scholar 

  28. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, Hartmann-Boyce J, Ryan R, Shepperd S, Thomas J (2020) Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. https://doi.org/10.1136/bmj.l6890

    Article  PubMed  PubMed Central  Google Scholar 

  29. McKenzie JE, Brennan SE (2019) Synthesizing and presenting findings using other methods. Cochrane Handb Syst Rev Interv. https://doi.org/10.1002/9781119536604.ch12

    Article  Google Scholar 

  30. López-López JA, Page MJ, Lipsey MW, Higgins JP (2018) Dealing with effect size multiplicity in systematic reviews and meta-analyses. Res Synth Methods 9:336–351. https://doi.org/10.1002/jrsm.1310

    Article  Google Scholar 

  31. McKenzie JE, Brennan SE, Ryan RE, Thomson HJ, Johnston RV (2019) Summarizing study characteristics and preparing for synthesis. Cochrane Handb Syst Rev Interv. https://doi.org/10.1002/9781119536604.ch9

    Article  Google Scholar 

  32. Ogilvie D, Fayter D, Petticrew M, Sowden A, Thomas S, Whitehead M, Worthy G (2008) The harvest plot: A method for synthesising evidence about the differential effects of interventions. BMC Med Res Methodol 8:8. https://doi.org/10.1186/1471-2288-8-8

    Article  PubMed  PubMed Central  Google Scholar 

  33. Snilstveit B, Oliver S, Vojtkova M (2012) Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. J Dev Eff 4:409–429. https://doi.org/10.1080/19439342.2012.710641

    Article  Google Scholar 

  34. (CFIR) CFfIr (2009) Table of 2009 CFIR Constructs. In: Editor (ed)^(eds) Book Table of 2009 CFIR Constructs. City, pp. https://cfirguide.org/constructs-old/

  35. Damschroder LJ, Reardon CM, OpraWiderquist MA, Lowery J (2022) Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum. Implement Sci 17:7. https://doi.org/10.1186/s13012-021-01181-5

    Article  PubMed  PubMed Central  Google Scholar 

  36. Research CRT-CfCM (2022) Consolidated Framework for Implementation Research. In: Book Consolidated Framework for Implementation Research. https://cfirguide.org. Accessed 2022

  37. Anh NTK, Yen LM, Nguyen NT, Nhat PTH, Thuy TTD, Phong NT, Tuyen PT, Yen NH, Chambers M, Hao NV (2021) Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit. PLoS ONE 16:e0247406. https://doi.org/10.1371/journal.pone.0247406

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Baker T, Schell CO, Lugazia E, Blixt J, Mulungu M, Castegren M, Eriksen J, Konrad D (2015) Vital signs directed therapy: improving care in an intensive care unit in a low-income country. PLoS ONE 10:e0144801. https://doi.org/10.1371/2Fjournal.pone.0144801

    Article  PubMed  PubMed Central  Google Scholar 

  39. Barahona-Guzman N, Rodríguez-Calderón ME, Rosenthal VD, Olarte N, Villamil-Gomez W, Rojas C, Rodríguez-Ferrer M, Sarmiento-Villa G, Lagares-Guzman A, Valderrama A (2014) Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in three cities of Colombia. Int J Infect Dis 19:67–73. https://doi.org/10.1016/j.ijid.2013.10.021

    Article  PubMed  Google Scholar 

  40. Booraphun S, Hantrakun V, Siriboon S, Boonsri C, Poomthong P, Singkaew B-O, Wasombat O, Chamnan P, Champunot R, Rudd K (2021) Effectiveness of a sepsis programme in a resource-limited setting: a retrospective analysis of data of a prospective observational study (Ubon-sepsis). BMJ Open 11:e041022. https://doi.org/10.1136/bmjopen-2020-041022

    Article  PubMed  PubMed Central  Google Scholar 

  41. Camacho EF, Boszczowski Í, Freire MP, Pinto FCG, Guimaraes T, Teixeira MJ, Costa SF (2013) Impact of an educational intervention implanted in a neurological intensive care unit on rates of infection related to external ventricular drains. PLoS ONE 8:e50708. https://doi.org/10.1371/journal.pone.0050708

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Cavalcanti AB, Bozza FA, Machado FR, Salluh JI, Campagnucci VP, Vendramim P, Guimaraes HP, Normilio-Silva K, Damiani LP, Romano E (2016) Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: a randomized clinical trial. JAMA 315:1480–1490. https://doi.org/10.1001/jama.2016.3463

    Article  CAS  PubMed  Google Scholar 

  43. Chakravarthy M, Myatra SN, Rosenthal VD, Udwadia F, Gokul B, Divatia J, Poojary A, Sukanya R, Kelkar R, Koppikar G (2015) The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India. J Infect Public Health 8:177–186. https://doi.org/10.1016/j.jiph.2014.08.004

    Article  PubMed  Google Scholar 

  44. Danchaivijitr S, Assanasen S, Apisarnthanarak A, Judaeng T, Pumsuwan V (2005) Effect of an education program on the prevention of ventilator-associated pneumonia: a multicenter study. J Med Assoc Thai 88:S36–S41

    PubMed  Google Scholar 

  45. Dehghanrad F, Nobakht-e-Ghalati Z, Zand F, Gholamzadeh S, Ghorbani M, Rosenthal V (2019) Effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of catheter associated urinary tract infection in intensive care unit patients. Electronic J General Med. https://doi.org/10.29333/ejgm/94099

    Article  Google Scholar 

  46. de Melo LS, de Abreu MV, de Oliveira Santos BR, Carreteiro MD, de Souza MF, de Albuquerque MC, de Lacerda Vidal CF, Lacerda HR (2021) Partnership among hospitals to reduce healthcare associated infections: a quasi-experimental study in Brazilian ICUs. BMC Infect Dis 21:1–9. https://doi.org/10.1186/s12879-022-07770-z

    Article  Google Scholar 

  47. Dilek A, Ülger F, Şaban E, Musa A, Leblebicioğlu H, Rosenthal VD (2012) Impact of education and process surveillance on device-associated health care-associated infection rates in a Turkish ICU: Findings of the international nosocomial infection control consortium (INICC). Balkan Med J 2012:88–92. https://doi.org/10.5152/balkanmedj.2011.028

    Article  Google Scholar 

  48. Ershova K, Savin I, Kurdyumova N, Wong D, Danilov G, Shifrin M, Alexandrova I, Sokolova E, Fursova N, Zelman V (2018) Implementing an infection control and prevention program decreases the incidence of healthcare-associated infections and antibiotic resistance in a Russian neuro-ICU. Antimicrob Resist Infect Control 7:1–11. https://doi.org/10.1186/s13756-018-0383-4

    Article  Google Scholar 

  49. Escobar MF, Carvajal JA, Nieto AJ, Messa A, Burgos JM, Echavarría MP, Granados M (2018) Model of obstetric attention based on critical care in Latin America. J Matern Fetal Neonatal Med 31:3139–3146. https://doi.org/10.1080/14767058.2017.1365128

    Article  PubMed  Google Scholar 

  50. Guanche-Garcell H, Morales-Pérez C, Rosenthal VD (2013) Effectiveness of a multidimensional approach for the prevention of ventilator-associated pneumonia in an adult intensive care unit in Cuba: findings of the International Nosocomial Infection Control Consortium (INICC). J Infect Public Health 6:98–107. https://doi.org/10.1016/j.jiph.2012.11.009

    Article  PubMed  Google Scholar 

  51. Guo Q, Li H-Y, Li Y-M, Nong L-B, Xu Y-D, He G-Q, Liu X-Q, Jiang M, Xiao Z-I, Zhong N-S (2014) Compliance with severe sepsis bundles and its effect on patient outcomes of severe community-acquired pneumonia in a limited resources country. Arch Med Sci 10:970–978. https://doi.org/10.5114/2Faoms.2014.46216

    Article  PubMed  PubMed Central  Google Scholar 

  52. Haniffa R, Lubell Y, Cooper BS, Mohanty S, Alam S, Karki A, Pattnaik R, Maswood A, Haque R, Pangeni R (2017) Impact of a structured ICU training programme in resource-limited settings in Asia. PLoS ONE 12:e0173483. https://doi.org/10.1371/journal.pone.0173483

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Higuera F, Rosenthal VD, Duarte P, Ruiz J, Franco G, Safdar N (2005) The effect of process control on the incidence of central venous catheter–associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 33:2022–2027. https://doi.org/10.1097/01.ccm.0000178190.89663.e5

    Article  PubMed  Google Scholar 

  54. Hussain K, Khan MF, Ambreen G, Raza SS, Irfan S, Habib K, Zafar H (2020) An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes. J Pharm Policy Pract 13:69. https://doi.org/10.1186/s40545-020-00272-w

    Article  PubMed  PubMed Central  Google Scholar 

  55. Jaggi N, Rodrigues C, Rosenthal VD, Todi SK, Shah S, Saini N, Dwivedy A, Udwadia F, Mehta P, Chakravarthy M (2013) Impact of an international nosocomial infection control consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India. Int J Infect Dis 17:e1218–e1224. https://doi.org/10.1016/j.ijid.2013.07.007

    Article  PubMed  Google Scholar 

  56. Jooste R, Roberts F, Mndolo S, Mabedi D, Chikumbanje S, Whitaker D, O’Sullivan E (2019) Global Capnography Project (GCAP): implementation of capnography in Malawi–an international anaesthesia quality improvement project. Anaesthesia 74:158–166. https://doi.org/10.1111/anae.14426

    Article  CAS  PubMed  Google Scholar 

  57. Kanj SS, Zahreddine N, Rosenthal VD, Alamuddin L, Kanafani Z, Molaeb B (2013) Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in an adult intensive care unit in Lebanon: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis 17:e686–e690. https://doi.org/10.1016/j.ijid.2013.01.020

    Article  PubMed  Google Scholar 

  58. Kesinger MR, Nagy LR, Sequeira DJ, Charry JD, Puyana JC, Rubiano AM (2014) A standardized trauma care protocol decreased in-hospital mortality of patients with severe traumatic brain injury at a teaching hospital in a middle-income country. Injury 45:1350–1354. https://doi.org/10.1016/j.injury.2014.04.037

    Article  PubMed  Google Scholar 

  59. Kisat M, Zafar SN, Hashmi ZG, Pardhan A, Mir T, Shah A, Haider AH, Zafar H (2016) Experience of damage control trauma laparotomy in a limited resource healthcare setting: a retrospective Cohort Study. Int J Surg 28:71–76. https://doi.org/10.1016/j.ijsu.2016.02.042

    Article  PubMed  PubMed Central  Google Scholar 

  60. Kovacevic P, Dragic S, Kovacevic T, Momcicevic D, Festic E, Kashyap R, Niven AS, Dong Y, Gajic O (2019) Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit. Crit Care 23:1–7. https://doi.org/10.1186/s13054-019-2494-6

    Article  Google Scholar 

  61. Laichuthai N, Khovidhunkit W, Boonchaya-anant P (2020) The efficacy and safety of an insulin infusion protocol in a medical intensive care unit at a tertiary care hospital: a prospective study. Int J Diabetes Dev Ctries 40:32–39. https://doi.org/10.1007/s13410-019-00731-4

    Article  CAS  Google Scholar 

  62. Leblebicioglu H, Ersoz G, Rosenthal VD, Nevzat-Yalcin A, Akan ÖA, Sirmatel F, Turgut H, Ozdemir D, Alp E, Uzun C (2013) Impact of a multidimensional infection control approach on catheter-associated urinary tract infection rates in adult intensive care units in 10 cities of Turkey: International Nosocomial Infection Control Consortium findings (INICC). Am J Infect Control 41:885–891. https://doi.org/10.1016/j.ajic.2013.01.028

    Article  PubMed  Google Scholar 

  63. Leblebicioglu H, Öztürk R, Rosenthal VD, Akan ÖA, Sirmatel F, Ozdemir D, Uzun C, Turgut H, Ersoz G, Koksal I (2013) Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 12:1–10. https://doi.org/10.1186/2F1476-0711-12-10

    Article  Google Scholar 

  64. Leblebicioglu H, Yalcin A, Rosenthal VD, Koksal I, Sirmatel F, Unal S, Turgut H, Ozdemir D, Ersoz G, Uzun C (2013) Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 41:447–456. https://doi.org/10.1007/s15010-013-0407-1

    Article  CAS  PubMed  Google Scholar 

  65. Leblebicioglu H, Koksal I, Rosenthal VD, Akan ÖA, Özgültekin A, Kendirli T, Erben N, Yalcin AN, Ulusoy S, Sirmatel F (2015) Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach, over 8 years, in 11 cities of Turkey. J Infect Prev 16:146–154. https://doi.org/10.1177/2F1757177414560249

    Article  PubMed  Google Scholar 

  66. Lobo RD, Levin AS, Gomes LMB, Cursino R, Park M, Figueiredo VB, Taniguchi L, Polido CG, Costa SF (2005) Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil. Am J Infect Control 33:83–87. https://doi.org/10.1016/j.ajic.2004.05.003

    Article  PubMed  Google Scholar 

  67. Lobo RD, Levin AS, Oliveira MS, Gomes LM, Gobara S, Park M, Figueiredo VB, de Vasconcelos SE, Costa SF (2010) Evaluation of interventions to reduce catheter-associated bloodstream infection: continuous tailored education versus one basic lecture. Am J Infect Control 38:440–448. https://doi.org/10.1016/j.ajic.2009.09.013

    Article  PubMed  Google Scholar 

  68. Machado FR, Ferreira EM, Schippers P, de Paula IC, Saes LSV, de Oliveira FI, Tuma P, Nogueira Filho W, Piza F, Guare S (2017) Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results. Crit Care 21:1–11. https://doi.org/10.1186/s13054-017-1858-z

    Article  Google Scholar 

  69. Manasia RJM, Husain SJ, Hooda K, Imran M, Bailey C (2014) Therapeutic hypothermia post-cardiac arrest: a clinical nurse specialist initiative in Pakistan. Clin Nurse Spec 28:231–239. https://doi.org/10.1097/nur.0000000000000057

    Article  PubMed  Google Scholar 

  70. Marra AR, Cal RGR, Durao MS, Correa L, Guastelli LR, Moura DF Jr, Edmond MB, Dos Santos OFP (2010) Impact of a program to prevent central line-associated bloodstream infection in the zero tolerance era. Am J Infect Control 38:434–439. https://doi.org/10.1016/j.ajic.2009.11.012

    Article  PubMed  Google Scholar 

  71. Mathur P, Tak V, Gunjiyal J, Nair SA, Lalwani S, Kumar S, Gupta B, Sinha S, Gupta A, Gupta D, Misra MC (2015) Device-associated infections at a level-1 trauma centre of a developing Nation: impact of automated surveillance, training and feedbacks. Indian J Med Microbiol 33:51–62. https://doi.org/10.4103/0255-0857.148378

    Article  CAS  PubMed  Google Scholar 

  72. Medeiros EA, Grinberg G, Rosenthal VD, Angelieri DB, Ferreira IB, Cechinel RB, Zanandrea BB, Rohnkohl C, Regalin M, Spessatto JL (2015) Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 3 cities in Brazil. Am J Infect Control 43:10–15. https://doi.org/10.1016/j.ajic.2014.10.001

    Article  PubMed  Google Scholar 

  73. Mehta Y, Jaggi N, Rosenthal V, Rodrigues C, Todi S, Saini N, Udwadia F, Karlekar A, Kothari V, Myatra S (2013) Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 21 adult intensive-care units from 10 cities in India: findings of the International Nosocomial Infection Control Consortium (INICC). Epidemiol Infect 141:2483–2491. https://doi.org/10.1017/s0950268813000381

    Article  CAS  PubMed  Google Scholar 

  74. Miranda-Novales MG, Sobreyra-Oropeza M, Rosenthal VD, Higuera F, Armas-Ruiz A, Pérez-Serrato I, Torres-Hernández H, Zamudio-Lugo I, Flores-Ruiz EM, Campuzano R (2019) Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach during 3 years in 6 hospitals in 3 Mexican cities. J Patient Saf 15:49–54. https://doi.org/10.1097/pts.0000000000000210

    Article  PubMed  Google Scholar 

  75. Leidy Katerine Calvo N, Antônio Capone N, Adriano José P, Eliézer S (2020) Quality improvement model (IHI) as a strategy to implement a sepsis protocol in a public hospital in Brazil. BMJ Open Quality 9:e000354. https://doi.org/10.1136/bmjoq-2018-000354

    Article  Google Scholar 

  76. Navoa-Ng JA, Berba R, Rosenthal VD, Villanueva VD, Tolentino MCV, Genuino GAS, Consunji RJ, Mantaring JBV III (2013) Impact of an International Nosocomial Infection Control Consortium multidimensional approach on catheter-associated urinary tract infections in adult intensive care units in the Philippines: International Nosocomial Infection Control Consortium (INICC) findings. J Infect Public Health 6:389–399. https://doi.org/10.1016/j.jiph.2013.03.002

    Article  PubMed  Google Scholar 

  77. Panditrao A, Shafiq N, Kumar-M P, Sekhon AK, Biswal M, Singh G, Kaur K, Ray P, Malhotra S, Gautam V, Gupta R, Gupta V, Yadav TD, Laroiya I, Kumar H, Salvania A (2021) Impact of an antimicrobial stewardship and monitoring of infection control bundle in a surgical intensive care unit of a tertiary-care hospital in India. J Global Antimicrob Resist 24:260–265. https://doi.org/10.1016/j.jgar.2021.01.003

    Article  CAS  Google Scholar 

  78. Ranzani OT, Simpson ES, Augusto TB, Cappi SB, Noritomi DT (2014) Evaluation of a minimal sedation protocol using ICU sedative consumption as a monitoring tool: a quality improvement multicenter project. Crit Care 18:1–16. https://doi.org/10.1186/2Fs13054-014-0580-3

    Article  Google Scholar 

  79. Rosenthal VD, Guzman S, Pezzotto SM (2003) Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control 31:405–409. https://doi.org/10.1067/mic.2003.52

    Article  PubMed  Google Scholar 

  80. Rosenthal VD, Guzman S, Safdar N (2004) Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol 25:47–50. https://doi.org/10.1086/502291

    Article  PubMed  Google Scholar 

  81. Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW (2003) Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control 31:85–92. https://doi.org/10.1067/mic.2003.63

    Article  PubMed  Google Scholar 

  82. Rosenthal VD, Guzman S, Safdar N (2005) Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 33:392–397. https://doi.org/10.1016/j.ajic.2004.08.009

    Article  PubMed  Google Scholar 

  83. Rosenthal VD, Guzman S, Crnich C (2006) Impact of an infection control program on rates of ventilator-associated pneumonia in intensive care units in 2 Argentinean hospitals. Am J Infect Control 34:58–63. https://doi.org/10.1016/j.ajic.2005.11.002

    Article  PubMed  Google Scholar 

  84. Rosenthal VD, Maki DG, Rodrigues C, Álvarez-Moreno C, Leblebicioglu H, Sobreyra-Oropeza M, Berba R, Madani N, Medeiros EA, Cuéllar LE (2010) Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central line–associated bloodstream infection rates in the intensive care units of 15 developing countries. Infect Control Hosp Epidemiol 31:1264–1272. https://doi.org/10.1086/657140

    Article  PubMed  Google Scholar 

  85. Rosenthal VD, Rodrigues C, Madani N, Mitrev Z, Ye G, Salomao R, Ulger F, Guanche-Garcell H, Kanj SS, Cuéllar LE (2012) Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in adult intensive care units from 14 developing countries of four continents: findings of the International Nosocomial Infection Control Consortium. Crit Care Med 40:3121–3128. https://doi.org/10.1097/ccm.0b013e3182657916

    Article  PubMed  Google Scholar 

  86. Rosenthal V, Todi S, Alvarez-Moreno C, Pawar M, Karlekar A, Zeggwagh A, Mitrev Z, Udwadia F, Navoa-Ng J, Chakravarthy M (2012) Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 40:517–526. https://doi.org/10.1007/s15010-012-0278-x

    Article  CAS  PubMed  Google Scholar 

  87. Rosenthal VD, Viegas M, Sztokhamer D, Benchetrit G, Santoro B, Lastra CE, Romani A, Núbila D, Alicia BM, Lanzetta D (2015) Impact of INICC multidimensional hand hygiene approach in ICUs in four cities in Argentina. J Nurs Care Qual 30:E17–E25. https://doi.org/10.1097/ncq.0000000000000134

    Article  PubMed  Google Scholar 

  88. Rosenthal VD, Desse J, Maurizi DM, Chaparro GJ, Orellano PW, Chediack V, Cabrera R, Golschmid D, Silva CG, Vimercati JC (2018) Impact of the International Nosocomial Infection Control Consortium’s multidimensional approach on rates of ventilator-associated pneumonia in 14 intensive care units in 11 hospitals of 5 cities within Argentina. Am J Infect Control 46:674–679. https://doi.org/10.1016/j.ajic.2017.11.021

    Article  PubMed  Google Scholar 

  89. Rosenthal VD, Desse J, Maurizi DM, Chaparro GJ, Orellano PW, Chediack V, Cabrera R, Golschmid D, Silva CG, Vimercati JC (2018) Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of central line-associated bloodstream infection in 14 intensive care units in 11 hospitals of 5 cities in Argentina. Infect Control Hosp Epidemiol 39:445–451. https://doi.org/10.1017/ice.2017.298

    Article  PubMed  Google Scholar 

  90. Saharman YR, Karuniawati A, Sedono R, Aditianingsih D, Qi H, Verbrugh HA, Severin JA (2021) Multimodal intervention to reduce acquisition of carbapenem-non-susceptible Gram-negative bacteria in intensive care units in the National Referral Hospital of Indonesia: an interrupted time series study. J Crit Care 64:237–244. https://doi.org/10.1016/j.jcrc.2021.04.016

    Article  CAS  PubMed  Google Scholar 

  91. Salahuddin N, Zafar A, Sukhyani L, Rahim S, Noor M, Hussain K, Siddiqui S, Islam M, Husain S (2004) Reducing ventilator-associated pneumonia rates through a staff education programme. J Hosp Infect 57:223–227. https://doi.org/10.1016/j.jhin.2004.03.002

    Article  CAS  PubMed  Google Scholar 

  92. Santana SL, Furtado GH, Wey SB, Medeiros EA (2008) Impact of an education program on the incidence of central line-associated bloodstream infection in 2 medical-surgical intensive care units in Brazil. Infect Control Hosp Epidemiol 29:1171–1173. https://doi.org/10.1086/591862

    Article  PubMed  Google Scholar 

  93. Su D, Hu B, Rosenthal VD, Li R, Hao C, Pan W, Tao L, Gao X, Liu K (2015) Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in five intensive care units in three cities of China. Public Health 129:979–988. https://doi.org/10.1016/j.puhe.2015.02.023

    Article  CAS  PubMed  Google Scholar 

  94. Tao L, Hu B, Rosenthal VD, Zhang Y, Gao X, He L (2012) Impact of a multidimensional approach on ventilator-associated pneumonia rates in a hospital of Shanghai: findings of the International Nosocomial Infection Control Consortium. J Crit Care 27:440–446. https://doi.org/10.1016/j.jcrc.2011.12.018

    Article  PubMed  Google Scholar 

  95. Tripathy S, Acharya SP, Sahoo AK, Mitra JK, Goel K, Ahmad SR, Hansdah U (2020) Intensive care unit (ICU) diaries and the experiences of patients’ families: a grounded theory approach in a lower middle-income country (LMIC). J Patient-Rep Outcomes 4:63. https://doi.org/10.1186/s41687-020-00229-2

    Article  PubMed  PubMed Central  Google Scholar 

  96. Vasava N, Damor P, Vasava J (2021) Multimodal strategy to improve hand hygiene compliance to practices among staff nurses. Indian J Forensic Med Toxicol. https://doi.org/10.37506/ijfmt.v15i4.16995

    Article  Google Scholar 

  97. Vukoja M, Dong Y, Adhikari NK, Schultz MJ, Arabi YM, Martin-Loeches I, Hache M, Gavrilovic S, Kashyap R, Gajic O (2021) Checklist for early recognition and treatment of acute illness and injury: an exploratory multicenter international quality-improvement study in the ICUs with variable resources. Crit Care Med 49:e598. https://doi.org/10.1097/ccm.0000000000004937

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Alberto L, Zotárez H, Cañete ÁA, Niklas JEB, Enriquez JM, Gerónimo MR, del Carmen MM, Chaboyer W (2014) A description of the ICU liaison nurse role in Argentina. Intensive Crit Care Nurs 30:31–37. https://doi.org/10.1016/j.iccn.2013.07.001

    Article  PubMed  Google Scholar 

  99. Apisarnthanarak A, Thongphubeth K, Sirinvaravong S, Kitkangvan D, Yuekyen C, Warachan B, Warren DK, Fraser VJ (2007) Effectiveness of multifaceted hospital wide quality improvement programs featuring an intervention to remove unnecessary urinary catheters at a tertiary care center in Thailand. Infect Control Hosp Epidemiol 28:791–798. https://doi.org/10.1086/518453

    Article  PubMed  Google Scholar 

  100. Many HR, Otoki K, Parker AS, Parker RK (2021) Implementation of a surgical critical care service reduces failure to rescue in emergency gastrointestinal surgery in rural Kenya: interrupted time-series analysis. Ann Surg. https://doi.org/10.1097/sla.0000000000005215

    Article  PubMed  Google Scholar 

  101. Kovacevic P, Jandric M, Kovacevic T, Momcicevic D, Zlojutro B, Baric G, Dragic S (2021) Impact of checklist for early recognition and treatment of acute illness on treatment of critically Ill septic patients in a low-resource medical intensive care unit. Microb Drug Resist 27:1203–1206. https://doi.org/10.1089/mdr.2020.0454

    Article  CAS  PubMed  Google Scholar 

  102. Chittawatanarat K, Pamorsinlapathum T (2011) The impact of closed ICU model on mortality in general surgical intensive care unit. J Med Assoc Thail 92:1627

    Google Scholar 

  103. Hashmi M, Kamal R (2013) Management of patients in a dedicated burns intensive care unit (BICU) in a developing country. Burns 39:493–500. https://doi.org/10.1016/j.burns.2012.07.027

    Article  PubMed  Google Scholar 

  104. Marotta C, Di Gennaro F, Pisani L, Pisani V, Senesie J, Bah S, Koroma MM, Caracciolo C, Putoto G, Amatucci F (2020) Cost-utility of intermediate obstetric critical care in a resource-limited setting: a value-based analysis. Ann Global Health. https://doi.org/10.5334/aogh.2907

    Article  Google Scholar 

  105. Vashistha N, Singhal D, Budhiraja S, Aggarwal B, Tobin R, Fotedar K (2018) Outcomes of Emergency Laparotomy (EL) Care Protocol at Tertiary Care Center from Low–Middle-Income Country (LMIC). World J Surg 42:1278–1284. https://doi.org/10.1007/s00268-017-4333-8

    Article  PubMed  Google Scholar 

  106. Vora TK, Karunakaran S, Kumar A, Chiluka A, Srinivasan H, Parmar K, Vasu ST, Srinivasan R, Chandan H, Vishnu P (2018) Intracranial pressure monitoring in diffuse brain injury—why the developing world needs it more? Acta Neurochir 160:1291–1299. https://doi.org/10.1007/s00701-018-3538-4

    Article  PubMed  Google Scholar 

  107. Abrão FC, de França SA, de Abreu IR, Neves Pereira JC, del Massa EC, Oliver A, Cavalcante MGC (2021) Enhanced recovery after surgery (ERAS®) protocol adapted to the Brazilian reality: a prospective cohort study for thoracic patients. J Thorac Dis 13:5439. https://doi.org/10.21037/jtd-21-920

    Article  PubMed  PubMed Central  Google Scholar 

  108. Azevedo J, Lima ERM, Cossetti RJD, Azevedo RPd (2007) Intensive insulin therapy versus conventional glycemic control in patients with acute neurological injury: a prospective controlled trial. Crit Care 11:1–2. https://doi.org/10.1590/s0004-282x2007000500001

    Article  Google Scholar 

  109. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, Petroni G, Lujan S, Pridgeon J, Barber J (2012) A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 367:2471–2481. https://doi.org/10.1056/nejmoa1207363

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  110. Chomba R, Moeng MS, Lowman W (2020) Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical trauma ICU: a prospective, two period cross-over, interventional study. S Afr J Surg 58:143–149

    Article  Google Scholar 

  111. Maia SB, Katz L, Neto CN, Caiado BV, Azevedo AP, Amorim MM (2014) Abbreviated (12-hour) versus traditional (24-hour) postpartum magnesium sulfate therapy in severe pre-eclampsia. Int J Gynecol Obstet 126:260–264. https://doi.org/10.1016/j.ijgo.2014.03.024

    Article  CAS  Google Scholar 

  112. Rangel-Frausto MS, Higuera-Ramirez F, Martinez-Soto J, Rosenthal VD (2010) Should we use closed or open infusion containers for prevention of bloodstream infections? Ann Clin Microbiol Antimicrob 9:1–8. https://doi.org/10.1186/2F1476-0711-9-6

    Article  Google Scholar 

  113. Wuthisuthimethawee P, Sookmee W, Damnoi S (2019) Non-randomized comparative study on the efficacy of a trauma protocol in the emergency department. Chin J Traumatol 22:207–211. https://doi.org/10.1016/j.cjtee.2019.04.003

    Article  PubMed  PubMed Central  Google Scholar 

  114. Rosenthal VD, Maki DG (2004) Prospective study of the impact of open and closed infusion systems on rates of central venous catheter–associated bacteremia. Am J Infect Control 32:135–141. https://doi.org/10.1016/j.ajic.2003.12.002

    Article  PubMed  Google Scholar 

  115. McNett M, O’Mathúna D, Tucker S, Roberts H, Mion LC, Balas MC (2020) A scoping review of implementation science in adult critical care settings. Crit Care Explor 2:e0301. https://doi.org/10.1097/cce.0000000000000301

    Article  PubMed  PubMed Central  Google Scholar 

  116. Kourtis SA, Burns JP (2019) Quality improvement in pediatric intensive care: a systematic review of the literature. Pediatr Investig 3:110–116. https://doi.org/10.1002/2Fped4.12133

    Article  PubMed  PubMed Central  Google Scholar 

  117. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, Wensing M, Dijkstra R, Donaldson C (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8:3–4. https://doi.org/10.3310/hta8060

    Article  Google Scholar 

  118. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C (2012) Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 50:217–226. https://doi.org/10.1097/mlr.0b013e3182408812

    Article  PubMed  PubMed Central  Google Scholar 

  119. Wolfenden L, Foy R, Presseau J, Grimshaw JM, Ivers NM, Powell BJ, Taljaard M, Wiggers J, Sutherland R, Nathan N, Williams CM, Kingsland M, Milat A, Hodder RK, Yoong SL (2021) Designing and undertaking randomised implementation trials: guide for researchers. BMJ 372:m3721. https://doi.org/10.1136/bmj.m3721

    Article  PubMed  PubMed Central  Google Scholar 

  120. Curtis JR, Cook DJ, Wall RJ, Angus DC, Bion J, Kacmarek R, Kane-Gill SL, Kirchhoff KT, Levy M, Mitchell PH (2006) Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Crit Care Med 34:211–218. https://doi.org/10.1097/01.ccm.0000190617.76104.ac

    Article  PubMed  Google Scholar 

  121. Walsh TS, Kydonaki K, Antonelli J, Stephen J, Lee RJ, Everingham K, Hanley J, Phillips EC, Uutela K, Peltola P (2016) Staff education, regular sedation and analgesia quality feedback, and a sedation monitoring technology for improving sedation and analgesia quality for critically ill, mechanically ventilated patients: a cluster randomised trial. Lancet Respir Med 4:807–817. https://doi.org/10.1016/s2213-2600(16)30178-3

    Article  PubMed  Google Scholar 

  122. McGill E, Marks D, Er V, Penney T, Petticrew M, Egan M (2020) Qualitative process evaluation from a complex systems perspective: a systematic review and framework for public health evaluators. PLoS Med 17:e1003368. https://doi.org/10.1371/journal.pmed.1003368

    Article  PubMed  PubMed Central  Google Scholar 

  123. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. https://doi.org/10.1136/bmj.a1655

    Article  PubMed  PubMed Central  Google Scholar 

  124. Groene O, Sunol R (2019) Quality improvement is complex and contextual. BMJ. https://doi.org/10.1136/bmj.l6155

    Article  PubMed  Google Scholar 

  125. Seys D, Panella M, VanZelm R, Sermeus W, Aeyels D, Bruyneel L, Coeckelberghs E, Vanhaecht K (2019) Care pathways are complex interventions in complex systems: New European Pathway Association framework. Int J Care Coord 22:5–9. https://doi.org/10.1177/2053434519839195

    Article  Google Scholar 

  126. SQUIRE (2020 ) Revised Standards for Quality Improvement Reporting Excellence, SQUIRE 2.0. In: Editor (ed)^(eds) Book Revised Standards for Quality Improvement Reporting Excellence, SQUIRE 2.0. City, pp. https://www.squire-statement.org/index.cfm?fuseaction=Page.ViewPage&PageID=471

  127. Wagstaff D, Moonesinghe SR (2023) Publishing quality improvement studies: learning to share and sharing to learn. BJA Open. https://doi.org/10.1016/j.bjao.2023.100123

    Article  PubMed  PubMed Central  Google Scholar 

  128. Bradley EH, Byam P, Alpern R, Thompson JW, Zerihun A, Abeb Y, Curry LA (2012) A systems approach to improving rural care in Ethiopia. PLoS ONE 7:e35042. https://doi.org/10.1371/journal.pone.0035042

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  129. Fulop NJ, Ramsay AI (2019) How organisations contribute to improving the quality of healthcare. BMJ. https://doi.org/10.1136/bmj.l1773

    Article  PubMed  PubMed Central  Google Scholar 

  130. Norris JM, White DE, Nowell L, Mrklas K, Stelfox HT (2017) How do stakeholders from multiple hierarchical levels of a large provincial health system define engagement? A qualitative study. Implement Sci 12:1–13. https://doi.org/10.1186/s13012-017-0625-5

    Article  Google Scholar 

  131. Alidina S, Chatterjee P, Zanial N, Alreja SS, Balira R, Barash D, Ernest E, Giiti GC, Maina E, Mazhiqi A (2021) Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others? BMJ Qual Saf 30:937–949. https://doi.org/10.1136/2Fbmjqs-2020-011795

    Article  PubMed  PubMed Central  Google Scholar 

  132. Drew JR, Pandit M (2020) Why healthcare leadership should embrace quality improvement. BMJ. https://doi.org/10.1136/bmj.m872

    Article  PubMed  PubMed Central  Google Scholar 

  133. Kwizera A, Sendagire C, Kamuntu Y, Rutayisire M, Nakibuuka J, Muwanguzi PA, Alenyo-Ngabirano A, Kyobe-Bosa H, Olaro C (2022) Building critical care capacity in a low-income country. Crit Care Clin 38:747–759. https://doi.org/10.1016/j.ccc.2022.07.003

    Article  PubMed  PubMed Central  Google Scholar 

  134. Murthy S, Adhikari NK (2013) Global health care of the critically ill in low-resource settings. Ann Am Thorac Soc 10:509–513. https://doi.org/10.1513/annalsats.201307-246ot

    Article  PubMed  Google Scholar 

  135. Jones E, Furnival J, Carter W (2019) Identifying and resolving the frustrations of reviewing the improvement literature: the experiences of two improvement researchers. BMJ Open Quality 8:e000701. https://doi.org/10.1136/bmjoq-2019-000701

    Article  PubMed  PubMed Central  Google Scholar 

  136. Dutta S, Jaffer AK (2016) Reporting quality improvement interventions: a call to action. Jt Comm J Qual Patient Saf 42:195. https://doi.org/10.1016/s1553-7250(16)42024-6

    Article  PubMed  Google Scholar 

  137. Wagstaff D, Warnakulasuriya S, Singleton G, Moonesinghe SR, Fulop N, Vindrola-Padros C (2022) A scoping review of local quality improvement using data from UK perioperative National Clinical Audits. Perioper Med 11:1–11. https://doi.org/10.1186/s13741-022-00273-0

    Article  Google Scholar 

  138. Hu ZJ, Fusch G, Hu C, Wang JY, El Helou Z, Hassan MT, Mbuagbaw L, El Helou S, Thabane L (2021) Completeness of reporting of quality improvement studies in neonatology is inadequate: a systematic literature survey. BMJ Open Qual 10:e001273. https://doi.org/10.1136/2Fbmjoq-2020-001273

    Article  PubMed  PubMed Central  Google Scholar 

  139. García-Elorrio E, Aziz S (2021) The need for standardized reporting of research findings in the field of quality of care. Int J Qual Health Care. https://doi.org/10.1093/intqhc/mzab040

    Article  PubMed  Google Scholar 

  140. Shojania K, MK WR (2004) Closing the quality gap: a critical analysis of quality improvement strategies (Vol. 1: series overview and methodology). (Technical Reviews, No. 9.1.) In: Book Closing the quality gap: a critical analysis of quality improvement strategies (Vol. 1: series overview and methodology). (Technical Reviews, No. 9.1.). https://www.ncbi.nlm.nih.gov/books/NBK43908/

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Acknowledgements

Guus ten Asbroek assisted with study design and data acquisition; Tiffany Gooden and Layoni Dullawe assisted with data collection. Covidence provided access to their online platform via their LMIC exceptions rate.

Funding

Resources to conduct the study are provided by the Wellcome Flagship Innovations award. (“Collaboration for Research, Implementation and Training in Critical Care in Asia and Africa”, reference 224048/Z/21/Z). Wellcome were not able to support making this paper Open Access in this journal.

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Authors and Affiliations

  1. University College London, London, UK

    Duncan Wagstaff, Patrick Chappel & Aasiyah Rashan

  2. The George Institute for Global Health, New Delhi, India

    Sumaiya Arfin

  3. Vrije Universiteit Amsterdam, Amsterdam, Netherlands

    Alba Korver

  4. Pandemic Sciences Hub and Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK

    Rashan Haniffa & Abi Beane

  5. NICS-MORU, Colombo, Sri Lanka

    Rashan Haniffa & Abi Beane

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  1. Duncan Wagstaff
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection was performed by DW, SA, AK, PC and AB. Analyses were performed by DW, SA, AR and AB. The first draft of the manuscript was written by DW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sumaiya Arfin.

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Conflicts of interest

The authors of this research work have no competing interests.

Ethical and regulatory considerations

Risk and harm: This systematic review uses existing data to analyse the effectiveness of quality improvement interventions. No harm is anticipated.

Informed consent

This study is a systematic review and as such does not include patient, provider, or public involvement. The data was collected from already published research. No consent was sought.

Benefits

This study synthesises existing evidence on approaches used, outcome measures employed to estimate effects and the nature of implementation challenges. This evidence will directly inform the design of future QI interventions internationally as part of CCAA (CRIT Care Asia; a Wellcome funded collaboration for registry enabled research, implementation, and training for critical and acute care in Asia and Africa)18. The beneficiaries of these published findings will thus be patients, clinicians, and researchers on critical care units in Asia, Africa and more globally.

Participant confidentiality

This study does not include patient identifiable data. Since all data used for analysis is freely accessible through the registries, no additional measures for data storage need to be taken. All collected data will remain the property of the contributing registries.

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The findings of this study are being disseminated through publication and aim to directly inform the design of future quality improvement interventions.

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Wagstaff, D., Arfin, S., Korver, A. et al. Interventions for improving critical care in low- and middle-income countries: a systematic review. Intensive Care Med (2024). https://doi.org/10.1007/s00134-024-07377-9

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