Pagel Christina, Brown Katherine L, McLeod Isobel, Jepps Helen, Wray Jo, Chigaru Linda, McLean Andrew, Treasure Tom, Tsang Victor, Utley Martin
Clinical Operational Research Unit, UCL, London, UK.
Department of Cardiorespiratory, Great Ormond Street Hospital for Children, London, UK.
BMJ Open. 2017 May 29;7(5):e014743. doi: 10.1136/bmjopen-2016-014743.
With survival following paediatric cardiac surgery improving, the attention of quality assurance and improvement initiatives is shifting to long-term outcomes and early surgical morbidities. We wanted to involve family representatives and a range of clinicians in selecting the morbidities to be measured in a major UK study.
Paediatric cardiac surgery services in the UK.
We convened a panel comprising family representatives, paediatricians from referring centres, and surgeons and other clinicians from surgical centres.
Using the nominal group technique augmented by a robust voting process to identify group preferences, suggestions for candidate morbidities were elicited, discussed, ranked and then shortlisted. The shortlist was passed to a clinical group that provided a view on the feasibility of monitoring each shortlisted morbidity in routine practice. The panel then met again to select a prioritised list of morbidities for further study, with the list finalised by the clinical group and chief investigators.
At the first panel meeting, 66 initial suggestions were made, with this reduced to a shortlist of 24 after two rounds of discussion, consolidation and voting. At the second meeting, this shortlist was reduced to 10 candidate morbidities. Two were dropped on grounds of feasibility and replaced by another the panel considered important. The final list of nine morbidities included indicators of organ damage, acute events and feeding problems. Family representatives and clinicians from outside tertiary centres brought some issues to greater prominence than if the panel had consisted solely of tertiary clinicians or study investigators.
The inclusion of patient and family perspectives in identifying metrics for use in monitoring a specialised clinical service is challenging but feasible and can broaden notions of quality and how to measure it.
随着小儿心脏手术患者生存率的提高,质量保证和改进措施的关注点正转向长期预后和早期手术并发症。我们希望让家庭代表和一系列临床医生参与到一项英国大型研究中,以选择需要测量的并发症。
英国的小儿心脏手术服务。
我们召集了一个由家庭代表、转诊中心的儿科医生以及手术中心的外科医生和其他临床医生组成的小组。
采用名义小组技术,并辅以严格的投票程序来确定小组偏好,从而引出、讨论、排序并最终筛选出候选并发症的建议。筛选名单被提交给一个临床小组,该小组就常规实践中监测每个入选并发症的可行性发表意见。然后,该小组再次开会,选出一份优先考虑的并发症清单以供进一步研究,该清单由临床小组和首席研究员最终确定。
在第一次小组会议上,共提出了66条初步建议,经过两轮讨论、整合和投票后,缩减为24项的筛选名单。在第二次会议上,该筛选名单缩减为10项候选并发症。其中两项因可行性原因被剔除,并被小组认为重要的另一项所取代。最终的九项并发症清单包括器官损伤、急性事件和喂养问题的指标。与仅由三级医疗机构的临床医生或研究调查人员组成小组相比,来自三级医疗机构以外的家庭代表和临床医生使一些问题更加突出。
将患者和家庭的观点纳入确定用于监测专业临床服务的指标具有挑战性,但可行,并且可以拓宽质量观念以及衡量质量的方式。