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Reducing low-value care in paediatric ICU
- Professor Lyvonne TumeProfessor of Critical Care Nursing
Key points
- A three-round Delphi study across UK staff from many disciplines identified the top 10 low-value care practices in paediatric ICUs.
- The top five included unnecessary blood gases and bloods, overuse of medicines such as PPIs, and unnecessary or prolonged fasting around procedures and extubation.
- Risk aversion affects care, the time it takes to deliver, and cost and environmental impact, and the paper is published open access in Nursing in Critical Care.
Professor Lyvonne Tume, Professor of Critical Care Nursing, discusses a multidisciplinary study identifying low-value practices in paediatric intensive care. She explains how a Delphi process brought together professional perspectives on interventions that may be unnecessary or offer limited benefit. Topics include routine blood sampling, medication review, fasting and the influence of risk aversion on everyday decisions. The interview explores why reducing low-value care matters for children and families as well as staff workload, resources and the environment. Professor Tume encourages teams to examine the evidence behind routine practice and consider where change could improve care.
This interview took place at the PCCS Annual Scientific Meeting 2026 in London.
Read the transcript
Automatic transcript, lightly edited for readability. It may contain errors, so check it against the video before quoting.
So I was going to talk briefly this morning about the study we did looking at identifying low value care practices in paediatric ICUs. So last year we did a Delphi study. We asked staff across the UK and we got a really high number of responses from lots of different disciplines, which was really important. We wanted to really identify what are the top 10, say, low value care practices that we do in paediatric ICU. So this was a three-round Delphi and we ended up coming up with 10.
The top five were reducing unnecessary blood gases, untimely bloods, the overuse of medicines and not stopping them in a timely manner. Specifically PPIs, proton pump inhibitors, were mentioned. Also things like unnecessary fasting for procedures, prolonged fasting, fasting for extubation and after extubation. These were some of the key things that came out.
And I think it's really important to consider all the stuff that we do that we think we need to do or we feel we need to do, and this risk aversion, and it really impacts on some of the care that we deliver, the time that we use to deliver the care, and money, and environmental impact which we increasingly have to consider. So I think it's a really useful paper. It's published in Nursing in Critical Care, open access, and well worth a read.
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Cite this video
Professor Lyvonne Tume. “Reducing low-value care in paediatric ICU.” The Paediatric Video Journal, 7 November 2026. https://paediatricvj.com/videos/reducing-low-value-care-in-paediatric-icu-tume/
This interview is educational content intended for healthcare professionals and is not medical advice. Views expressed are those of the speaker. © The Paediatric Video Journal. All rights reserved.