gms | German Medical Science

Background: The Dutch Health Care Authority published three reports on the shortcomings in the organization of perioperative patient care.

Context: A multiprofessional working group developed three guidelines on perioperative processes with the aim to improve patient safety. Since there is little evidence, recommendations are mainly based on expert opinion and best practices. An efficient and transparant consensus method was required.

Description of best practice: In an overnight ‘pressure cooker’ meeting a core group analyzed the perioperative process and identified important safety items. Literature searches were carried out on the main topics. The core group formulated concept recommendations based on this analysis, literature, expert opinion and best practices. A broad expert group discussed the concept recommendations using an online modified Delphi procedure, Synmind, which is specifically developed for discussion and decision making. Experts scored the importance of these recommendations for patient safety. They motivated their score and gave suggestions for improvement. They discussed the results of the Synmind session in a plenary meeting to reach final agreement. Feasability of the recommendations was tested in five hospitals.

Lessons for guideline developers, adaptors, implementers, and/or users:

• Working with a core group facilitates keeping the momentum in guideline development.
• A single multi-day meeting can be more productive than multiple short meetings.
• An online Delphi procedure in combination with a single plenary meeting is an efficient procedure to structure and formalize the consensus process.
• This process can be completed within months.