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A regional massive hemorrhage protocol developed through a modified Delphi technique.

Jeannie L Callum1, Calvin H Yeh2, Andrew Petrosoniak2

  • 1Departments 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. Jeannie.Callum@sunnybrook.ca.

CMAJ Open
|September 6, 2019
PubMed
Summary

A standardized massive hemorrhage protocol (MHP) was developed using expert consensus to improve patient care during life-threatening bleeding. Harmonizing MHPs enhances training, communication, and patient outcomes.

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Area of Science:

  • Medical Science
  • Trauma Care
  • Transfusion Medicine

Background:

  • Massive hemorrhage protocols (MHPs) facilitate rapid blood component delivery for exsanguinating patients.
  • Variability in MHP implementation, content, and compliance presents challenges.
  • Developing a standardized regional MHP is crucial for consistent care.

Purpose of the Study:

  • Identify key evidence-based principles for a standardized regional MHP.
  • Establish quality indicators for MHP implementation.

Main Methods:

  • Modified Delphi consensus technique with 36 experts.
  • Independent rating of 43 statements and 8 quality indicators on a 7-point Likert scale.
  • Inclusion of external stakeholder input from Ontario hospitals.

Main Results:

  • Consensus reached on 42 statements and 8 quality indicators.
  • Modifications incorporated from external stakeholders.
  • Foundation established for a proposed MHP.

Conclusions:

  • A template for a harmonized MHP toolkit was created.
  • Recommendations for pediatric, obstetrical, and resource-limited settings included.
  • Harmonization aims to simplify training, increase uptake, improve communication, and enhance patient safety and outcomes.