Construction of a nursing quality evaluation index system for inter-hospital transport of critically ill patients with respiratory infectious diseases

Background　The inter-hospital transfer of critically ill patients with respiratory infectious diseases involves high risks and multiple procedures, with a relatively high incidence of adverse transfer events. However, the existing nursing quality assessment lacks a specific evaluation index system. Objective　To construct a nursing quality evaluation index system for interhospital transfer of critically ill patients with respiratory infectious diseases, thereby providing references for evaluating nursing quality and ensuring patient safety during transfer. Methods　Based on Donabedian's three-dimensional structure theory, an initial indicator pool was derived through literature analysis. Semi-structured interviews were conducted with 12 healthcare professionals, ambulance drivers, and family members of patients to supplement the indicators and form a preliminary version of the index system. From February to August 2025, 15 experts in emergency nursing, critical care nursing, infectious disease nursing, infection prevention and control, and related fields were selected to participate in three rounds of Delphi expert consultation for indicator screening and revision. The analytic hierarchy process was used to determine the weights of indicators at each level, and the final evaluation index system was established. Results　Literature analysis yielded 3 first-level, 13 second-level, and 40 third-level indicators. Semi-structured interviews generated 11 themes and added practical indicators such as psychological care during transfer and management of occupational exposure, resulting in a preliminary system comprising 3 first-level (structure, process, outcome), 11 second-level, and 45 third-level indicators. In each of the three Delphi rounds, 15 questionnaires were distributed, and the effective response rate was 100%. The expert authority coefficients were 0.83, 0.89, and 0.91, respectively; the Kendall's coefficients of concordance for the overall set of indicators were 0.184, 0.194, and 0.185 (all P ＜ 0.001). After three rounds of revision, the final nursing quality evaluation index system consisted of 3 first-level indicators (organizational system and resource preparation, fullprocess management of transfer, and transfer quality and safety evaluation), 9 second-level indicators, and 27 third-level indicators. Conclusion　The constructed nursing quality evaluation index system for inter-hospital transfer of critically ill patients with respiratory infectious diseases has complete dimensions and reasonable weights, providing a scientific reference framework for standardized assessment and continuous improvement of transfer nursing quality for this patient population.