通过改良德尔菲技术制定的区域大规模出血预案。
A regional massive hemorrhage protocol developed through a modified Delphi technique.
作者信息
Callum Jeannie L, Yeh Calvin H, Petrosoniak Andrew, McVey Mark J, Cope Stephanie, Thompson Troy, Chin Victoria, Karkouti Keyvan, Nathens Avery B, Murto Kimmo, Beno Suzanne, Pendergrast Jacob, McDonald Andrew, MacDonald Russell, Adhikari Neill K J, Alam Asim, Arnold Donald, Barratt Lee, Beckett Andrew, Brenneman Sue, Chaudhry Hina Razzaq, Collins Allison, Harvey Margaret, Lampron Jacinthe, Margarido Clarita, McFarlan Amanda, Nascimento Barto, Owens Wendy, Pai Menaka, Rizoli Sandro, Ruijs Theodora, Skeate Robert, Skelton Teresa, Sholzberg Michelle, Syer Kelly, Viveiros Jami-Lynn, Theriault Josee, Tinmouth Alan, Van Heest Rardi, White Susan, Zeller Michelle, Pavenski Katerina
机构信息
Departments of Laboratory Medicine and Molecular Diagnostics (Callum, Chin, Viveiros), Surgery (Nathens, Nascimento), Emergency Services (McDonald), Critical Care Medicine (Adhikari) and Anesthesia (Margarido), Sunnybrook Health Sciences Centre; Departments of Laboratory Medicine and Pathobiology (Callum, Pendergrast, Skeate, Pavenski), Anesthesia (McVey, Karkouti, Alam, Margarido), Surgery (Nathens, Nascimento, Rizoli) and Paediatrics (Beno), University of Toronto; Division of Emergency Medicine (Yeh, Petrosoniak, McDonald, MacDonald), Department of Medicine, University of Toronto; Departments of Emergency Medicine (Petrosoniak), Surgery (Rizoli) and Laboratory Medicine (Sholzberg, Pavenski), St. Michael's Hospital; Department of Anesthesia and Pain Medicine (McVey, Skelton), The Hospital for Sick Children; Ontario Regional Blood Coordinating Network (Cope, Thompson, Collins, Owens); Department of Anesthesia and Pain Management (Karkouti), Sinai Health System, University Health Network, and Women's College Hospital, Toronto, Ont.; Department of Anesthesiology and Pain Medicine (Murto), Children's Hospital of Eastern Ontario; Department of Anesthesiology and Pain Medicine (Murto), University of Ottawa, Ottawa, Ont.; Paediatric Emergency Medicine (Beno), The Hospital for Sick Children; Department of Clinical Pathology (Pendergrast), University Health Network, Toronto, Ont.; Ornge Transport Medicine (McDonald, MacDonald), Mississauga, Ont.; Interdepartmental Division of Critical Care Medicine (Adhikari), University of Toronto; Department of Anesthesia (Alam, Arnold), North York General Hospital, Toronto, Ont.; McMaster Centre for Transfusion Research (Arnold, Pai, Zeller); Departments of Medicine (Pai, Zeller) and Pathology and Molecular Medicine (Pai), McMaster University, Hamilton, Ont.; Canadian Blood Services (Arnold, Skeate, White); St. Michael's Hospital (Barratt, Chaudhry, Harvey), Toronto, Ont.; Department of Surgery (Beckett), McGill University, Montréal, Que.; Canadian Forces Health Services (Beckett), Ottawa, Ont.; Sunnybrook Health Sciences Centre (Brenneman), Toronto, Ont.; General Surgery, Acute Care and Trauma (Lampron), The Ottawa Hospital; Departments of Surgery (Lampron), Medicine (Tinmouth) and Laboratory Medicine and Pathology (Tinmouth), Faculty of Medicine, University of Ottawa, Ottawa, Ont.; Trauma Program and Quality Assurance (McFarlan), St. Michael's Hospital, Toronto, Ont.; Departments of Pathology (Ruijs) and Surgery (Van Heest), William Osler Health Centre, Brampton, Ont.; Lakeridge Health Corporation (Syer), Oshawa, Ont.; Department of Critical Care (Theriault), Health Sciences North, Sudbury, Ont.; Division of Hematology (Tinmouth), The Ottawa Hospital; University of Ottawa Centre for Transfusion Research (Tinmouth), Ottawa Hospital Research Institute, Ottawa, Ont.; Canadian Blood Services (Zeller), Ancaster, Ont.
出版信息
CMAJ Open. 2019 Sep 3;7(3):E546-E561. doi: 10.9778/cmajo.20190042. Print 2019 Jul-Sep.
BACKGROUND
A massive hemorrhage protocol (MHP) enables rapid delivery of blood components in a patient who is exsanguinating pending definitive hemorrhage control, but there is variability in MHP implementation rates, content and compliance owing to challenges presented by infrequent activation, variable team performance and patient acuity. The goal of this project was to identify the key evidence-based principles and quality indicators required to develop a standardized regional MHP.
METHODS
A modified Delphi consensus technique was performed in the spring and summer of 2018. Panellists used survey links to independently review and rate (on a 7-point Likert scale) 43 statements and 8 quality indicators drafted by a steering committee composed of transfusion medicine specialists and technologists, and trauma physicians. External stakeholder input from all hospitals in Ontario was sought.
RESULTS
Three rounds were held with 36 experts from diverse clinical backgrounds. Consensus was reached for 42 statements and 8 quality indicators. Additional modifications from external stakeholders were incorporated to form the foundation for the proposed MHP.
INTERPRETATION
This MHP template will provide the basis for the design of an MHP toolkit, including specific recommendations for pediatric and obstetrical patients, and for hospitals with limited availability of blood components or means to achieve definitive hemorrhage control. We believe that harmonization of MHPs in our region will simplify training, increase uptake of evidence-based interventions, enhance communication, improve patient comfort and safety, and, ultimately, improve patient outcomes.
背景
大量出血预案（MHP）能够在患者因大出血而濒临死亡等待最终止血时迅速提供血液成分，但由于激活频率低、团队表现各异以及患者病情严重程度不同等挑战，MHP的实施率、内容和依从性存在差异。本项目的目标是确定制定标准化区域MHP所需的关键循证原则和质量指标。
方法
2018年春夏季采用改良的德尔菲共识技术。小组成员通过调查链接独立审查并（按7点李克特量表）对由输血医学专家、技术人员和创伤科医生组成的指导委员会起草的43条陈述和8项质量指标进行评分。征求了安大略省所有医院外部利益相关者的意见。
结果
与来自不同临床背景的36位专家进行了三轮讨论。就42条陈述和8项质量指标达成了共识。纳入了外部利益相关者的其他修改意见，为拟议的MHP奠定了基础。
解读
此MHP模板将为设计MHP工具包提供依据，包括针对儿科和产科患者以及血液成分供应有限或无法实现最终止血的医院的具体建议。我们相信，本地区MHP的统一将简化培训、增加循证干预措施的采用、加强沟通、提高患者舒适度和安全性，并最终改善患者预后。
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