Implementation of good humanization practices in a pediatric intensive care unit: An audit and feedback quality improvement study

Abstract

Objectives: To describe the implementation of the Manual of Good Practices in Humanization in Pediatric Intensive Care Units through an Audit and Feedback strategy and examine observed changes in compliance in a high-complexity unit. Methods: A comparative longitudinal observational study (pre–post) was conducted from January to December 2025 in a high-complexity pediatric intensive care unit in Spain. The implementation process followed a 12-month Audit and Feedback cycle structured in four phases: baseline audit, participatory prioritization, decentralized protocol development, and final evaluation. Compliance with 127 evaluable good practices was measured, and 95% confidence intervals were calculated using the Wilson score method. Results: Baseline compliance was 69.3% (88/127; 95% CI: 60.8–76.6). At final evaluation, overall compliance reached 72.4% (92/127; 95% CI: 64.1–79.5), representing an absolute increase of 3.1 percentage points (95% CI: −7.9 to +14.2). The prioritized strategic lines of Communication and Patient well-being showed gains of 14.3 and 8.3 percentage points, respectively; however, overlapping confidence intervals indicate that these changes cannot be distinguished from sampling variability. Among unimplemented practices, 87.2% required organizational and training actions, while 12.8% required direct financial investment. Conclusions: This implementation-focused quality improvement study suggests that Audit and Feedback may be feasible for structuring the monitoring, prioritization, and adoption of humanization practices in a high-complexity pediatric intensive care unit. Modest quantitative changes and organizational outputs were observed, but these findings cannot be considered evidence of intervention effectiveness. Future cycles should assess sustainability and incorporate patient-and family-level outcomes.