Building consensus on inpatient discharge pathway components in the management of blunt thoracic injuries: An e-Delphi study amongst an international professional expert panel

Abstract

Introduction: Access to a standardised and evidence informed approach to blunt thoracic injury (BTI) management remains challenging across organised trauma systems globally. It remains important to optimise recovery through pathway-based interventions. The aim of this study was to identify components of care that are important in the effective discharge process for patients with BTI and pinpoint core and optional components for a patient pathway-based intervention.Methods: Components of care within the hospital discharge process after BTI were identified using existing literature and expert opinion. These initial data were entered into a three-round e-Delphi consensus method where round one involved further integrating and categorising components of discharge care from the expert panel. The panel comprised of an international interdisciplinary group of healthcare professionals with experience in the management of BTI. All questionnaires were completed anonymously using an online survey and involved rating care components using Likert scales (Range: 1-6). The final consensus threshold for pathway components were defined as a group rating of greater than 70% scoring in either the moderate importance (3-4) or high importance category (5-6) and less than 15% of the panel scoring within the low importance category (1-2). Results: Of 88 recruited participants, 67 (76%) participated in round one. Statements were categorised into nine themes: (i) Discharge criteria; (ii) Physical function and Self-care; (iii) Pain management components; (iv) Respiratory function components; (v) General care components; (vi) Follow-up; (vii) Psychological care components; (viii) Patient, family and communication; (ix) 'Red Flag' signs and symptoms.Overall, 70 statements were introduced into the consensus building exercise in round two. In round three, 40 statements from across these categorises achieved consensus amongst the expert panel, forming a framework of core and optional care components within the discharge process after BTI.Conclusions: These data will be used to build a toolkit containing guidance on developing discharge pathways for patients with BTI and for the development of audit benchmarks for analysing healthcare provision in this area. It is important that interventions developed using this framework are validated locally and evaluated for efficacy using appropriate research methodology.

Correlação entre a força muscular respiratória e a força muscular periférica dos pacientes com drenagem torácica fechada

“…Pain management improves vital capacity, chest expansion and inspiratory capacity. This implies a shorter hospital stay and more efficiency in performing breathing exercises and mobilization [7,33].…”

“…Only 10% of blunt trauma and 30% of penetrating trauma require major surgery [5]. The presence of drains, pain and rib fractures may favor the decline in respiratory muscle strength in these patients [6][7][8].…”

Examining the role of lived experience consultants in an Australian research study on the educational experiences of children and young people in out-of-home care

“…The study employed a Delphi methodology which involved administration of two survey ‘rounds’ with people that had professional or personal experience of OOHC. This process involved interactive and multistage ‘rounds’ designed to capture expert opinions across key stakeholders (Hsu and Sandford, 2007 ) , and to develop a consensus concerning the educational challenges of children and young people in OOHC (Baker et al, 2021). To establish consensus, the results of the first survey round are analysed and used to inform development of the second, and possibly third, survey round.…”