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B170 Establishing consensus to improve access to regional anaesthesia for rib fracture patients using delphi methodology
  1. WHD Spencer and
  2. G Simpson
  1. The Royal Devon and Exeter NHS Trust, Exeter, UK


Background and Aims In 2017, our hospital implemented a dedicated multi-disciplinary chest trauma pathway, which recommends regional anaesthesia techniques for patients at high risks of complications1. The number of patients identified with rib fractures on admission has increased resulting in referral for regional anaesthesia in 176 patients in 2021 alone. This has increased the workload of the on-call anaesthesia service and can result in delays. We used Delphi methodology to inform improvements within this service.

Methods Using Delphi methodology, an expert panel of consultant anaesthetists were invited to provide possible solutions to improve access to regional anaesthesia and patient flow in emergency theatres. Responses were then presented to the panel to score their agreement with each solution using a Likert scale from 1 (completely disagree) to 5 (completely agree). Solutions with a mean of >4.0, and standard deviation (SD) <1.0 were considered to have reached consensus. Solutions that failed to gain consensus were returned to the panel for a further round of scoring, with statistics from the previous round revealed. Anonymity was assured.

Results 22 consultants were invited to participate, and responses were summarised into 14 solutions (table 1). We received 13 responses in Round 1 and 8 in Round 2 of the Delphi process. In total, 5 solutions reached consensus (graph 1).

Abstract B170 Table 1

Conclusions Delphi methodology allows an equal voice, anonymity, and the consideration of a wide range of opinions and solutions. Limitations include a low response rate and inadvertent introduction of bias. However, gaining expert consensus is highly beneficial in informing service improvement.

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