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 Callum, Jeannie L.
A1 Yeh, Calvin H.
A1 Petrosoniak, Andrew
A1 McVey, Mark J.
A1 Cope, Stephanie
A1 Thompson, Troy
A1 Chin, Victoria
A1 Karkouti, Keyvan
A1 Nathens, Avery B.
A1 Murto, Kimmo
A1 Beno, Suzanne
A1 Pendergrast, Jacob
A1 McDonald, Andrew
A1 MacDonald, Russell
A1 Adhikari, Neill K.J.
A1 Alam, Asim
A1 Arnold, Donald
A1 Barratt, Lee
A1 Beckett, Andrew
A1 Brenneman, Sue
A1 Chaudhry, Hina Razzaq
A1 Collins, Allison
A1 Harvey, Margaret
A1 Lampron, Jacinthe
A1 Margarido, Clarita
A1 McFarlan, Amanda
A1 Nascimento, Barto
A1 Owens, Wendy
A1 Pai, Menaka
A1 Rizoli, Sandro
A1 Ruijs, Theodora
A1 Skeate, Robert
A1 Skelton, Teresa
A1 Sholzberg, Michelle
A1 Syer, Kelly
A1 Viveiros, Jami-Lynn
A1 Theriault, Josee
A1 Tinmouth, Alan
A1 Van Heest, Rardi
A1 White, Susan
A1 Zeller, Michelle
A1 Pavenski, Katerina
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.