Construction of a sensitive indicator evaluation system for sepsis care quality: a three-stage mixed-method Delphi study

BackgroundThe development of care-sensitive quality indicators represents an essential component of care management. Currently, there exists no objective, scientific, and sensitive assessment framework for evaluating sepsis care quality management in China.Methods and designThis mixed-methods investigation employed a three-phase design. Initially, a systematic literature review (2014–2024) across four databases identified evidence regarding sepsis care quality. Subsequently, semi-structured interviews were conducted with five clinical experts from emergency departments and intensive care units (ICUs) to examine their perspectives on nursing-sensitive quality indicators (NSQIs). Finally, a modified Delphi process engaged a multidisciplinary panel to refine and validate sepsis-specific NSQIs through systematic consensus-building.ResultsTwo rounds of expert consultation were completed with a questionnaire return rate of 100%. Sixteen experts, consisting of 10 nurses and 6 physicians, participated in the first and second rounds of the Delphi survey, respectively. The mean score of the expert authority coefficient Cr for the two rounds was 0.95 and 0.96 (Cr ≥ 0.7). The coordination coefficient (Kendall W) was 0.120-0.316 (p < 0.001) in the first round and 0.116–0.142 (p < 0.001) in the second round, both of which reached a significant consensus. A comprehensive list of sensitive indicators for sepsis care quality was established, encompassing three primary, nine secondary, and 30 tertiary indicators.ConclusionThe established NSQIs encompass three fundamental dimensions of sepsis care quality: importance, rationality, and feasibility.Clinical practice implicationsThis research provides a valuable framework for evaluating clinical care quality in sepsis management.