A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England
Abstract Background Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those respon...
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doaj-4e9d5da4aecc4287a5dcefd00a45598a2020-11-24T22:00:46ZengBMCBMC Health Services Research1472-69632018-02-0118111010.1186/s12913-018-2922-3A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in EnglandKristoffer Halvorsrud0Darren Flynn1Gary A. Ford2Peter McMeekin3Ajay Bhalla4Joyce Balami5Dawn Craig6Phil White7Institute of Health and Society Newcastle UniversityInstitute of Health and Society Newcastle UniversityInstitute of Neuroscience, Newcastle UniversitySchool of Health, Community and Education Studies, Northumbria UniversityGuy’s and St Thomas’ NHS Foundation TrustCentre for Evidence Based Medicine, University of OxfordInstitute of Health and Society Newcastle UniversityInstitute of Neuroscience, Newcastle UniversityAbstract Background Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. Methods A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Results Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. Conclusions The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.http://link.springer.com/article/10.1186/s12913-018-2922-3Delphi exerciseService organisationConsensusNeurointerventionIntra-arterial thrombectomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kristoffer Halvorsrud Darren Flynn Gary A. Ford Peter McMeekin Ajay Bhalla Joyce Balami Dawn Craig Phil White |
spellingShingle |
Kristoffer Halvorsrud Darren Flynn Gary A. Ford Peter McMeekin Ajay Bhalla Joyce Balami Dawn Craig Phil White A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England BMC Health Services Research Delphi exercise Service organisation Consensus Neurointervention Intra-arterial thrombectomy |
author_facet |
Kristoffer Halvorsrud Darren Flynn Gary A. Ford Peter McMeekin Ajay Bhalla Joyce Balami Dawn Craig Phil White |
author_sort |
Kristoffer Halvorsrud |
title |
A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England |
title_short |
A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England |
title_full |
A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England |
title_fullStr |
A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England |
title_full_unstemmed |
A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England |
title_sort |
delphi study and ranking exercise to support commissioning services: future delivery of thrombectomy services in england |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2018-02-01 |
description |
Abstract Background Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. Methods A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Results Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. Conclusions The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre. |
topic |
Delphi exercise Service organisation Consensus Neurointervention Intra-arterial thrombectomy |
url |
http://link.springer.com/article/10.1186/s12913-018-2922-3 |
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