Nasal high flow therapy in remote hospitals: guideline development using a modified Delphi technique.

Area of Science:

• Paediatric critical care
• Rural and remote health services
• Respiratory medicine

Background:

• Remote Australian hospitals lack onsite paediatric intensive care units (PICUs), necessitating aeromedical retrievals for tertiary care.
• Nasal high flow (NHF) therapy is crucial for paediatric respiratory conditions but its implementation is inconsistent in rural Queensland.
• A need exists for standardized NHF therapy protocols in remote settings to ensure equitable access to care.

Purpose of the Study:

• To develop a context-specific clinical guideline for the implementation of NHF therapy in three remote hospitals in Torres Strait and Cape York.
• To improve consistent and equitable access to NHF therapy for paediatric patients with acute respiratory distress in remote areas.
• To address challenges related to delayed treatment and limited access to services in remote healthcare settings.

Main Methods:

• A modified Delphi technique was employed, involving an expert panel of remote clinicians, retrieval specialists, paediatricians, and NHF therapy experts.
• Iterative roundtable discussions were conducted to formulate remote-specific guidelines.
• The process incorporated literature review and expert consensus on key implementation issues.

Main Results:

• Remote-specific decisions were reached on critical aspects including environment of care, medication use, staff training, observation regimes, and consultation frequency.
• Guidelines were developed to mitigate delays in local treatment arrangements and aeromedical retrievals.
• Strategies were established to address challenges such as limited trained staff, staffing levels, and supply chain issues.

Conclusions:

• A contextualized clinical guideline for NHF therapy in remote hospitals was successfully developed using a modified Delphi technique.
• The guideline aims to enhance consistency and safety by reducing workplace practice delays and improving access to trained staff and resources.
• Implementation of this guideline is expected to improve health and social outcomes for children with acute respiratory distress in remote settings.