A regional massive hemorrhage protocol developed through a modified Delphi technique

摘要: Background A massive hemorrhage protocol (MHP) enables rapid delivery of blood components in a patient who is exsanguinating pending definitive control, but there variability MHP implementation rates, content and compliance owing to challenges presented by infrequent activation, variable team performance acuity. The goal this project was identify the key evidence-based principles quality indicators required develop standardized regional MHP. Methods modified Delphi consensus technique performed spring summer 2018. Panellists used survey links independently review rate (on 7-point Likert scale) 43 statements 8 drafted steering committee composed transfusion medicine specialists technologists, trauma physicians. External stakeholder input from all hospitals Ontario sought. Results Three rounds were held with 36 experts diverse clinical backgrounds. Consensus reached for 42 indicators. Additional modifications external stakeholders incorporated form foundation proposed Interpretation This template will provide basis design an toolkit, including specific recommendations pediatric obstetrical patients, limited availability or means achieve control. We believe that harmonization MHPs our region simplify training, increase uptake interventions, enhance communication, improve comfort safety, and, ultimately, outcomes.