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Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project
  1. Hassan M Ahmed1,
  2. Benjamin P Atterton2,
  3. Gillian G Crowe2,
  4. Jaime L Barratta3,
  5. Mark Johnson4,
  6. Eugene Viscusi3,
  7. Sanjib Adhikary5,
  8. Eric Albrecht6,7,
  9. Karen Boretsky8,
  10. Jan Boublik9,
  11. Dara S Breslin10,
  12. Kelly Byrne11,
  13. Alan Ch'ng4,
  14. Alwin Chuan12,
  15. Patrick Conroy13,
  16. Craig Daniel14,
  17. Andrzej Daszkiewicz15,
  18. Alain Delbos16,
  19. Dan Sebastian Dirzu17,
  20. Dmytro Dmytriiev18,
  21. Paul Fennessy19,
  22. H Barrie J Fischer20,
  23. Henry Frizelle21,
  24. Jeff Gadsden22,
  25. Philippe Gautier23,
  26. Rajnish K Gupta24,
  27. Yavuz Gürkan25,
  28. Harold David Hardman26,
  29. William Harrop-Griffiths27,
  30. Peter Hebbard28,29,
  31. Nadia Hernandez30,
  32. Jakub Hlasny31,
  33. Gabriella Iohom32,33,
  34. Vivian H Y Ip34,
  35. Christina L Jeng35,
  36. Rebecca L Johnson36,
  37. Hari Kalagara37,
  38. Brian Kinirons38,
  39. Andrew Kenneth Lansdown39,
  40. Jody C Leng40,41,
  41. Yean Chin Lim42,
  42. Clara Lobo43,
  43. Danielle B Ludwin44,
  44. Alan James Robert Macfarlane45,46,
  45. Anthony T Machi47,
  46. Padraig Mahon32,
  47. Stephen Mannion48,
  48. David H McLeod49,
  49. Peter Merjavy50,
  50. Aleksejs Miscuks51,
  51. Christopher H Mitchell52,
  52. Eleni Moka53,
  53. Peter Moran38,
  54. Ann Ngui4,
  55. Olga C Nin54,
  56. Brian D O'Donnell32,
  57. Amit Pawa55,56,
  58. Anahi Perlas57,58,
  59. Steven Porter59,
  60. John-Paul Pozek60,
  61. Humberto C Rebelo61,
  62. Vicente Roqués62,
  63. Kristopher M Schroeder63,
  64. Gary Schwartz64,
  65. Eric S Schwenk3,
  66. Luc Sermeus65,
  67. George Shorten32,33,66,
  68. Karthikeyan Srinivasan13,
  69. Markus F Stevens67,
  70. Kassiani Theodoraki68,
  71. Lloyd R Turbitt69,
  72. Luis Fernando Valdés-Vilches70,
  73. Thomas Volk71,72,
  74. Katrina Webster73,74,
  75. T Wiesmann75,76,
  76. Sylvia H Wilson77,
  77. Morné Wolmarans78,
  78. Glenn Woodworth79,
  79. Andrew K Worek80 and
  80. E M Louise Moran2
  1. 1Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  2. 2Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
  3. 3Department of Anesthesiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
  4. 4Department of Anaesthesia, Fiona Stanley Hospital and Freemantle Hospitals, Perth, Western Australia, Australia
  5. 5Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
  6. 6Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland
  7. 7Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
  8. 8Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  9. 9Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA
  10. 10Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland
  11. 11Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand
  12. 12Department of Anaesthesia, Liverpool Hospital, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
  13. 13Department of Anaesthesia, Tallaght University Hospital, Dublin, Ireland
  14. 14Department of Anaesthesia and Pain Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia
  15. 15Faculty of Medical Sciences, Unit of Pain Research and Treatment, Medical University of Silesia, Zabrze, Poland
  16. 16Department of Anaesthesia, Clinique Medipole Garonne, Toulouse, France
  17. 17Department of Anesthesia and Intensive Care, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
  18. 18Department of Anaesthesiology, Intensive Care and Pain Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
  19. 19Department of Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
  20. 20Retired Consultant Anaesthetist, Worcester Royal Hospital, Worcester, UK
  21. 21Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
  22. 22Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
  23. 23Department of Anesthesia, Clinique Sainte Anne Saint Remi, Bruxelles, Belgium
  24. 24Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  25. 25Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Turkey
  26. 26Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  27. 27Department of Anaesthesia, St Mary's Hospital, Imperial College, London, UK
  28. 28Ultrasound Education Unit, University of Melbourne, Melbourne, Victoria, Australia
  29. 29Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
  30. 30Department of Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA
  31. 31Department of Anaesthesiology and Intensive Care, F D Roosevelt Teaching Hospital, Banska Bystrica, Slovakia
  32. 32Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland
  33. 33School of Medicine, University College Cork, Cork, Ireland
  34. 34Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
  35. 35Department of Anesthesiology, Perioperative and Pain Medicine and Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  36. 36Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
  37. 37Department of Anesthesiology and Perioperative Medicine, The University of Alabama, Birmingham, Alabama, USA
  38. 38Department of Anaesthesia, Galway University Hospitals, Galway, Ireland
  39. 39Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  40. 40Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
  41. 41Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA
  42. 42Department of Anesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
  43. 43Department of Anaesthesia, Hospital das Forças Armadas, Porto, Portugal
  44. 44Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA
  45. 45Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary, Glasgow, UK
  46. 46School of Medicine, University of Glasgow, Glasgow, UK
  47. 47Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
  48. 48Department of Anaesthesia, South Infirmary Victoria University Hospital, Cork, Ireland
  49. 49Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia
  50. 50Department of Anaesthesia, Craigavon Area University Teaching Hospital, Craigavon, UK
  51. 51Department of Anaesthesiology, Hospital of Traumatology and Orthopaedics, University of Latvia, Riga, Latvia
  52. 52Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  53. 53Department of Anaesthesiology, Creta InterClinic Hospital, Hellenic Healthcare Group, Heraklion-Crete, Greece
  54. 54Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
  55. 55Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
  56. 56Faculty of Life Sciences and Medicine, King's College London, London, UK
  57. 57Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada
  58. 58Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  59. 59Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
  60. 60Department of Anesthesiology, University of Kansas Health System, Kansas City, Kansas, USA
  61. 61Department of Anaesthesiology, Hospital Luz Arrábida, Vila Nova de Gaia, Portugal
  62. 62Department of Anaesthesia and Intensive Care Medicine, Virgen de la Arrixaca University Hospital, Murcia, Spain
  63. 63Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  64. 64Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA
  65. 65Department of Anesthesia, Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium
  66. 66Insight II, SFI Research Centre, Cork, Ireland
  67. 67Department of Anesthesiology, Amsterdam Univeristy Medical Centers, Amsterdam, Netherlands
  68. 68Department of Anesthesiology, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece
  69. 69Department of Anaesthesia, Royal Victoria Hospital, Belfast, UK
  70. 70Department of Anesthesiology and Reanimation, Hospital Costa del Sol, Marbella, Spain
  71. 71Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital, Homburg, Germany
  72. 72Faculty of Medicine, Saarland University, Homburg, Germany
  73. 73Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia
  74. 74School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
  75. 75Department of Anesthesiology & Intensive Care Medicine, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
  76. 76Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum, Schwäbisch Hall, Germany
  77. 77Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
  78. 78Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  79. 79Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
  80. 80Post and Post LLC, Berwyn, Pennsylvania, USA
  1. Correspondence to Dr E M Louise Moran, Department of Anaesthesia, Letterkenny University Hospital, Letterkenny F92 AE81, Donegal, Ireland; lmoran75{at}gmail.com

Abstract

Background and objectives Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.

Methods Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%–74% agreement.

Results Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29.

Conclusion By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

  • nerve block
  • regional anesthesia
  • anesthesia
  • neuraxial
  • documentation
  • minimum standards
  • Delphi process
  • international consensus

Data availability statement

Data are available on reasonable request. Any data not in the online supplemental information are available on reasonable request.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/rapm-2021-103136

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    Data availability statement

    Data are available on reasonable request. Any data not in the online supplemental information are available on reasonable request.

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    Supplementary materials

    Footnotes

    • HMA, BPA and GGC are joint first authors.

    • Twitter @HassanM31118046, @sanjibadhikary, @DrEAlbrecht, @janboublik MDPhD, @AlwinChuan, @DanDirzu, @dr_rajgupta, @hdhardman_david, @HlasnyJakub, @rljohnsonmd, @TheLansdowns, @claralexlobo, @ajrmacfarlane, @PeterMerjavy, @PetermoranPeter, @amit_pawa, @PerlasAnahi, @KristopherSchr6, @garyschwartzmd, @ESchwenkMD, @LouiseMoran75

    • Correction notice This article has been corrected since it was first published. The open access licence has been updated to CC BY.

    • Contributors Study conception and design: HMA, BPA, GGC, JLB, MJ, EV, EMLM and AKW. Study conduct: HMA, BPA, GGC, JLB, MJ, EV and EMLM. Data analysis: BPA and GGC. Manuscript preparation: HMA, BPA, GGC, JLB, MJ, EV and EMLM. Manuscript revision: all authors. Manuscript approval: all authors. Manuscript guarantor: EMLM

    • Funding The authors received a grant towards the cost of open access from The European Society of Regional Anaesthesia and Pain Therapy

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.