Poster Presentation ANZTS Trauma 2024 Conference

Composition, quality and delivery of Major Haemorrhage Protocols (MHPs) and critical bleeding clinical practice guidelines in hospitals across Queensland Health (21408)

Josea Brown 1 , Jessica Forbes 1 , Elizabeth Wake 1 2 , Shane George 2 3 4 , James Winearls 5 , Michael Reade 6 , Michelle Jeffress 7 , Daniel Bodnar 8 9 , James McCullough 5 , Clinton Gibbs 10 , Alistair Hamilton 11 , Caitlin Brandenburg 12 13 , John Casey 14 , Natasha Adams 15 , Paressa Creswell 1
  1. Trauma Service, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
  2. School of Medicine, Griffith University, Gold Coast, Qld, Australia
  3. Paediatric Intensive Care Unit, Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
  4. Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
  5. Intensive Care Unit, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
  6. Intensive Care Unit, Royal Brisbane and Women's Hospital Metro North Hospital and Health Service, Brisbane, QLD, Australia
  7. Healthcare Improvement Unit Clinical Excellence Queensland, Department of Health , Brisbane, QLD, Australia
  8. Queensland Ambulance Service, Brisbane, QLD, Australia
  9. Emergency Department, Royal Brisbane and Women's Hospital Metro North Hospital and Health Service, Brisbane, QLD, Australia
  10. Retrieval Services Queensland, Northern Operations - RSQ, Townsville, QLD, Australia
  11. Emergency Department, Toowoomba Hospital Darling Downs Hospital and Health Service, Toowoomba, QLD, Australia
  12. Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, QLD, Australia
  13. Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
  14. Pathology Queensland Central Laboratory, RBWH Metro North Hospital and Health Service, Brisbane, QLD, Australia
  15. High Acuity Response Unit, Queensland Ambulance Service, Brisbane, QLD, Australia

Introduction

Massive Haemorrhage Protocols are widely used in the initial resuscitation phase to facilitate clinical decision making. Despite evidence-based guidelines which advise on the content and delivery of MHPs, variations continue to exist. To address these variations, an initial examination of MHPs must occur to understand the quality of guidance.

 

Study Aim

To compare MHPs from public hospitals in Queensland for content and quality using the AGREE II tool.  

 

Methods

MHPs were obtained from the Queensland Health intranet for all hospital and health services. Each MHP was assessed using a 7-point Likert scale against the six domains of the AGREE II; scope & purpose; stakeholder engagement; rigor of development; clarity of representation; applicability and editorial independence. A quality score was calculated for each domain, expressed as a percentage.

 

Results

22 MHPs were independently assessed by 14 reviewers. Quality scores ranged from 0%-86%.  ‘Scope and Purpose’ and ‘Clarity of Presentation’ were rated high quality (63%, 58%). ‘Editorial Independence’ and ‘Rigour of Development’ domains were rated ‘very low’ quality (11%, 17%); over half (55%, n=12) were rated acceptable for use. The combined quality of MHPs was moderate to low.

 

Conclusion

Despite the moderate to low quality scores, over half of the MHPs were deemed acceptable to use in clinical practice. These results reflect a tension between the clinical useability and relevance, and academic requirements to ensure high quality guidelines are developed. Involving stakeholders with expert research skills who can assist clinicians when developing guidelines could be a strategy to improve the quality of MHPs.