AM23-TU-02-O: Designing and optimizing massive hemorrhage protocols (Enduring)

While massive transfusion protocols have been widely implemented for management of hemorrhaging patients, they vary in components and may not include an ongoing assessment process. Using a structured method to assess evidence and reach consensus, a massive hemorrhage protocol was developed for use by all hospitals in the province of Ontario. This session describes the multidisciplinary approach to developing the protocol and quality indicators. The experience of designing and implementing the Massive Hemorrhage Toolkit for an entire province is markedly different from the vast majority of massive transfusion protocols designed and implemented in the US. With a population of >14M and >140 hospitals, this initiative presented a unique challenge. A multidisciplinary steering committee was formed and tasked with selecting experts for their panels and creating, administering, and analyzing the results of surveys. Experts were selected from all major stakeholder specialties. Preliminary recommendations were generated by the steering committee based on results from the initial provincial survey and literature review, reflecting the most up-to-date evidence. A Delphi method was used to achieve consensus among the expert panel and build the MHP framework. There were three rounds of surveys with post-survey discussions. Panelists were asked to rank each statement using a 7-point Likert scale. Following the conclusion of three rounds of surveys, items were reviewed by the steering committee for the creation of the final protocol. This final protocol was sent to a wide array of external stakeholders for assessment of content and ease of use. In the United States, each hospital with a trauma center must create their own massive transfusion protocol, but these can vary based on the clinician stakeholders and hospital size.