Documentation in Pediatric Microlaryngoscopy/Bronchoscopy: International Modified Delphi Consensus

Penelope Neocleous, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Agnieszka Dzioba, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Julie Strychowsky, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Murad Husein, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Evan J. Propst, Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Lily Hp Nguyen, Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
Nikolaus E. Wolter, Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Peng You, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Sukgi Choi, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Michele Torre, Department of Otolaryngology - Head and Neck Surgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
George Zalzal, Department of Otolaryngology - Head and Neck Surgery, Children's National Medical Center, George Washington University, District of Columbia, Washington, USA.
Sanjay Parikh, Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
Deepak Mehta, Department of Otolaryngology - Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
M Elise Graham, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

Document Type

Journal Article

Publication Date

7-16-2022

Journal

The Laryngoscope

DOI

10.1002/lary.30286

Keywords

Delphi; bronchoscopy; documentation; laryngoscopy; operative note

Abstract

BACKGROUND: Complete and accurate documentation of surgical procedures is essential for optimizing patient care, yet significant variation in operative notes persists within and across institutions. We sought to reach consensus on the most important components of an operative note for pediatric microlaryngoscopy and bronchoscopy. METHODS: A modified Delphi consensus process was used. A checklist for operative documentation, created by fellowship-trained pediatric otolaryngologists-head and neck surgeons, was sent to surgeons identified as experts in pediatric laryngoscopy and bronchoscopy. In the first round, items were rated as "keep" or "remove". In the second round, each item was rated on a 7-point Likert scale for importance. The mean score of each item was calculated to determine if consensus was reached. RESULTS: Overall, 43/74 (58.1%) surgeons responded to our survey. After two rounds of editing, 28 components reached consensus, 24 were near consensus, and 26 did not reach consensus. Items that reached final consensus had mean (SD) ratings of 6.12 (0.94) (range, 5.31-6.72). CONCLUSION: Pediatric otolaryngologists identified as bronchoscopy experts were able to create a checklist of essential components of an operative note for pediatric laryngoscopy and bronchoscopy using a Delphi method. Items reaching consensus included procedure name, description of breathing, grade of airway view, description of normal anatomic structures, grade of subglottic stenosis if present, presence and description of tracheobronchomalacia, presence of fistulae, cleft and rings, and several special cases including foreign body and tracheostomy management, as well as end of procedure disposition and complications. LEVEL OF EVIDENCE: 5 Laryngoscope, 2022.

Department

Surgery

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