Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk?
Objectives To examine whether the use of process mapping and a multidisciplinary Delphi can identify potential contributors to perioperative risk. We hypothesised that this approach may identify factors not represented in common perioperative risk tools and give insights of use to future research in...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/11/e064105.full |
| _version_ | 1798018112935690240 |
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| author | Ari Ercole Nicholas Levy Tom Bashford John Clarkson Daniel Stubbs Fay Gilder Basil Nourallah |
| author_facet | Ari Ercole Nicholas Levy Tom Bashford John Clarkson Daniel Stubbs Fay Gilder Basil Nourallah |
| author_sort | Ari Ercole |
| collection | DOAJ |
| description | Objectives To examine whether the use of process mapping and a multidisciplinary Delphi can identify potential contributors to perioperative risk. We hypothesised that this approach may identify factors not represented in common perioperative risk tools and give insights of use to future research in this area.Design Multidisciplinary, modified Delphi study.Setting Two centres (one tertiary, one secondary) in the UK during 2020 amidst coronavirus pressures.Participants 91 stakeholders from 23 professional groups involved in the perioperative care of older patients. Key stakeholder groups were identified via process mapping of local perioperative care pathways.Results Response rate ranged from 51% in round 1 to 19% in round 3. After round 1, free text suggestions from the panel were combined with variables identified from perioperative risk scores. This yielded a total of 410 variables that were voted on in subsequent rounds. Including new suggestions from round two, 468/519 (90%) of the statements presented to the panel reached a consensus decision by the end of round 3. Identified risk factors included patient-level factors (such as ethnicity and socioeconomic status), and organisational or process factors related to the individual hospital (such as policies, staffing and organisational culture). 66/160 (41%) of the new suggestions did not feature in systematic reviews of perioperative risk scores or key process indicators. No factor categorised as ‘organisational’ is currently present in any perioperative risk score.Conclusions Through process mapping and a modified Delphi we gained insights into additional factors that may contribute to perioperative risk. Many were absent from currently used risk stratification scores. These results enable an appreciation of the contextual limitations of currently used risk tools and could support future research into the generation of more holistic data sets for the development of perioperative risk assessment tools. |
| first_indexed | 2024-04-11T16:18:27Z |
| format | Article |
| id | doaj.art-2d555a3810d04f5e800db42ae73ff474 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-11T16:18:27Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-2d555a3810d04f5e800db42ae73ff4742022-12-22T04:14:26ZengBMJ Publishing GroupBMJ Open2044-60552022-11-01121110.1136/bmjopen-2022-064105Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk?Ari Ercole0Nicholas Levy1Tom Bashford2John Clarkson3Daniel Stubbs4Fay Gilder5Basil Nourallah6Division of Anaesthesia, University of Cambridge Department of Medicine, Cambridge, UKDepartment of Anaesthesia, West Suffolk Hospital, Bury Saint Edmunds, UKHealthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UKHealthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UKHealthcare Design Group, Department of Engineering, University of Cambridge, Cambridge, UKPrincess Alexandra Hospital NHS Trust, Harlow, UKDepartment of Anaesthesia, West Suffolk Hospital, Bury Saint Edmunds, UKObjectives To examine whether the use of process mapping and a multidisciplinary Delphi can identify potential contributors to perioperative risk. We hypothesised that this approach may identify factors not represented in common perioperative risk tools and give insights of use to future research in this area.Design Multidisciplinary, modified Delphi study.Setting Two centres (one tertiary, one secondary) in the UK during 2020 amidst coronavirus pressures.Participants 91 stakeholders from 23 professional groups involved in the perioperative care of older patients. Key stakeholder groups were identified via process mapping of local perioperative care pathways.Results Response rate ranged from 51% in round 1 to 19% in round 3. After round 1, free text suggestions from the panel were combined with variables identified from perioperative risk scores. This yielded a total of 410 variables that were voted on in subsequent rounds. Including new suggestions from round two, 468/519 (90%) of the statements presented to the panel reached a consensus decision by the end of round 3. Identified risk factors included patient-level factors (such as ethnicity and socioeconomic status), and organisational or process factors related to the individual hospital (such as policies, staffing and organisational culture). 66/160 (41%) of the new suggestions did not feature in systematic reviews of perioperative risk scores or key process indicators. No factor categorised as ‘organisational’ is currently present in any perioperative risk score.Conclusions Through process mapping and a modified Delphi we gained insights into additional factors that may contribute to perioperative risk. Many were absent from currently used risk stratification scores. These results enable an appreciation of the contextual limitations of currently used risk tools and could support future research into the generation of more holistic data sets for the development of perioperative risk assessment tools.https://bmjopen.bmj.com/content/12/11/e064105.full |
| spellingShingle | Ari Ercole Nicholas Levy Tom Bashford John Clarkson Daniel Stubbs Fay Gilder Basil Nourallah Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? BMJ Open |
| title | Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? |
| title_full | Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? |
| title_fullStr | Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? |
| title_full_unstemmed | Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? |
| title_short | Can process mapping and a multisite Delphi of perioperative professionals inform our understanding of system-wide factors that may impact operative risk? |
| title_sort | can process mapping and a multisite delphi of perioperative professionals inform our understanding of system wide factors that may impact operative risk |
| url | https://bmjopen.bmj.com/content/12/11/e064105.full |
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