RT Journal Article
SR Electronic
T1 A regional massive hemorrhage protocol developed through a modified Delphi technique
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E546
OP E561
DO 10.9778/cmajo.20190042
VO 7
IS 3
A1 Jeannie L. Callum
A1 Calvin H. Yeh
A1 Andrew Petrosoniak
A1 Mark J. McVey
A1 Stephanie Cope
A1 Troy Thompson
A1 Victoria Chin
A1 Keyvan Karkouti
A1 Avery B. Nathens
A1 Kimmo Murto
A1 Suzanne Beno
A1 Jacob Pendergrast
A1 Andrew McDonald
A1 Russell MacDonald
A1 Neill K.J. Adhikari
A1 Asim Alam
A1 Donald Arnold
A1 Lee Barratt
A1 Andrew Beckett
A1 Sue Brenneman
A1 Hina Razzaq Chaudhry
A1 Allison Collins
A1 Margaret Harvey
A1 Jacinthe Lampron
A1 Clarita Margarido
A1 Amanda McFarlan
A1 Barto Nascimento
A1 Wendy Owens
A1 Menaka Pai
A1 Sandro Rizoli
A1 Theodora Ruijs
A1 Robert Skeate
A1 Teresa Skelton
A1 Michelle Sholzberg
A1 Kelly Syer
A1 Jami-Lynn Viveiros
A1 Josee Theriault
A1 Alan Tinmouth
A1 Rardi Van Heest
A1 Susan White
A1 Michelle Zeller
A1 Katerina Pavenski
YR 2019
UL http://www.cmajopen.ca/content/7/3/E546.abstract
AB 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.