Gunz Anna C, Dhanani Sonny, Whyte Hillary, Menon Kusum, Foster Jennifer R, Parker Melissa J, McNally J Dayre
1Division of Critical Care, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 2Division of Neonatology, Department of Paediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada. 3Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. 4Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, ON, Canada. 5Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada.
Pediatr Crit Care Med. 2014 Sep;15(7):653-9. doi: 10.1097/PCC.0000000000000171.
Children must often be transported to dedicated pediatric centers to receive specialized medical and surgical care, which places them at risk for significant deterioration and life-threatening events. Studies designed to identify and mitigate these events have been limited by variability in the selection and definition of significant events. The objective of this study was to identify and evaluate indicators that represent significant events during the transport of pediatric patients and are relevant to future research initiatives in transport medicine.
We conducted a modified Delphi study consisting of four iterations.
The expert panel included Canadian, interdisciplinary healthcare providers with transport experience.
In the first Delphi iteration, experts suggested indicators for consideration and evaluated proposed indicators from the literature and introduced by the study steering committee. In subsequent iterations, respondents reevaluated all indicators that had not yet achieved a priori-defined consensus; group comments and aggregate scores for each indicator from previous iterations were provided.
The expert panel consisted of 16 physicians and 17 nonphysician healthcare providers from 10 Canadian institutions. In total, the panel evaluated 57 indicators, including 26 not previously presented in the literature. The expert panel determined 52 were significant and relevant to future studies in pediatric transport. The final indicator list includes trigger tools (interventions, physiological markers, and laboratory values) and team member safety and process issues.
Using a systematic, modified Delphi approach, we developed an inclusive list of indicators for application to pediatric transport-related quality improvement and clinical research projects.
儿童常常需要被转运至专门的儿科中心以接受专科医疗和外科护理，这使他们面临病情显著恶化和危及生命事件的风险。旨在识别和减轻这些事件的研究受到重大事件选择和定义变异性的限制。本研究的目的是识别和评估代表儿科患者转运期间重大事件且与未来转运医学研究计划相关的指标。
我们进行了一项包含四个迭代的改良德尔菲研究。
专家小组包括具有转运经验的加拿大跨学科医疗服务提供者。
在第一次德尔菲迭代中，专家们提出供考虑的指标，并评估了文献中提出的以及研究指导委员会引入的指标。在随后的迭代中，受访者重新评估所有尚未达成预先定义共识的指标；提供了前几次迭代中每个指标的小组评论和综合得分。
专家小组由来自加拿大10个机构的16名医生和17名非医生医疗服务提供者组成。该小组总共评估了57项指标，包括26项以前文献中未出现过的指标。专家小组确定其中52项对于儿科转运的未来研究具有重要意义且相关。最终的指标清单包括触发工具（干预措施、生理标志物和实验室值）以及团队成员安全和流程问题。
通过采用系统的改良德尔菲方法，我们制定了一份全面的指标清单，用于儿科转运相关的质量改进和临床研究项目。
