Development of key interventions and quality indicators for the management of an adult potential donor after brain death: a RAND modified Delphi approach

Abstract

BackgroundA substantial degree of variability in practices exists amongst donor hospitals regarding the donor detection, determination of brain death, application of donor management techniques or achievement of donor management goals. A possible strategy to standardize the donation process and to optimize outcomes could lie in the implementation of a care pathway. The aim of the study was to identify and select a set of relevant key interventions and quality indicators in order to develop a specific care pathway for donation after brain death and to rigorously evaluate its impact.MethodsA RAND modified three-round Delphi approach was used to build consensus within a single country about potential key interventions and quality indicators identified in existing guidelines, review articles, process flow diagrams and the results of the Organ Donation European Quality System (ODEQUS) project. Comments and additional key interventions and quality indicators, identified in the first round, were evaluated in the following rounds and a subsequent physical meeting. The study was conducted over a 4-month time period in 2016.ResultsA multidisciplinary panel of 18 Belgian experts with different relevant backgrounds completed the three Delphi rounds. Out of a total of 80 key interventions assessed throughout the Delphi process, 65 were considered to contribute to the quality of care for the management of a potential donor after brain death; 11 out of 12 quality indicators were validated for relevance and feasibility. Detection of all potential donors after brain death in the intensive care unit and documentation of cause of no donation were rated as the most important quality indicators.ConclusionsUsing a RAND modified Delphi approach, consensus was reached for a set of 65 key interventions and 11 quality indicators for the management of a potential donor after brain death. This set is considered to be applicable in quality improvement programs for the care of potential donors after brain death, while taking into account each country’s legislation and regulations regarding organ donation and transplantation.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3386-1) contains supplementary material, which is available to authorized users.

Indicadores de calidad para unidades de cuidados intensivos respiratorios

“…En años recientes la aparición de grupos colaborativos ha derivado en la propuesta de indicadores de calidad para grupos específicos de pacientes de las distintas ramas de atención de la medicina crítica que se adapten cada vez más a sus necesidades. [11][12][13][14][15] Parte del trabajo colaborativo de este grupo consistió en identificar aspectos relevantes de las UCIRs, priorizarlos y construir indicadores reuniendo a un grupo de expertos y con el apoyo logístico de instituciones dedicadas a la medicina respiratoria y del paciente crítico como son el COMMEC y el Consejo Nacional de Neumología en México. En las sesiones de trabajo se eligieron, por consenso, aquellos indicadores que reunían condiciones de validez (incluyendo su validez aparente), sensibilidad y especificidad.…”

CEPP: Canadian Extracorporeal Life Support (ECLS) Protocol Project

“…The RAND/UCLA Delphi Method used in similar studies was adapted for this project. 13,14 A 9-member panel with J o u r n a l P r e -p r o o f expertise in critical care, cardiac surgery, cardiology, emergency medicine, and internal medicine was assembled for this process.…”

“…The RAND/University of California, Los Angeles Delphi Method used in similar studies was adapted for this project. 13 , 14 A 9-member panel with expertise in critical care, cardiac surgery, cardiology, emergency medicine, and internal medicine was assembled for this process. Panel members represented relevant disciplines, geographic distribution, and institution types, including lung transplantation, cardiac transplantation, and cardiac surgery programs.…”

“…A 9-point Likert scale was used, and a key element was considered important if it obtained a median score of 7 or more. 13 Panelists were required to provide rationale for scores of 5 or lower.…”

Treatment patterns and unmet needs in adults with classic congenital adrenal hyperplasia: A modified Delphi consensus study

“…Controlled feedback in the form of a well-organized summary of the prior iteration allows each participant an opportunity to generate additional insights, clarify the information developed in previous iterations, and minimize the effects of noise. The Delphi method has been used successfully for various medical applications, from the assessment of knowledge gaps to the development of treatment guidelines (29)(30)(31)(32)(33). This study utilizes a modified Delphi method to survey expert opinions on the management of adult patients with classic CAH, as well as unmet needs in this patient population.…”