Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Hassan M Ahmed¹, Benjamin P Atterton², Gillian G Crowe², Jaime L Barratta³, Mark Johnson⁴, Eugene Viscusi³, Sanjib Adhikary⁵, Eric Albrecht^{6

7}, Karen Boretsky⁸, Jan Boublik⁹, Dara S Breslin¹⁰, Kelly Byrne¹¹, Alan Ch'ng⁴, Alwin Chuan¹², Patrick Conroy¹³, Craig Daniel¹⁴, Andrzej Daszkiewicz¹⁵, Alain Delbos¹⁶, Dan Sebastian Dirzu¹⁷, Dmytro Dmytriiev¹⁸, Paul Fennessy¹⁹, H Barrie J Fischer²⁰, Henry Frizelle²¹, Jeff Gadsden²², Philippe Gautier²³, Rajnish K Gupta²⁴, Yavuz Gürkan²⁵, Harold David Hardman²⁶, William Harrop-Griffiths²⁷, Peter Hebbard^{28

29}, Nadia Hernandez³⁰, Jakub Hlasny³¹, Gabriella Iohom^{32

33}, Vivian H Y Ip³⁴, Christina L Jeng³⁵, Rebecca L Johnson³⁶, Hari Kalagara³⁷, Brian Kinirons³⁸, Andrew Kenneth Lansdown³⁹, Jody C Leng^{40

41}, Yean Chin Lim⁴², Clara Lobo⁴³, Danielle B Ludwin⁴⁴, Alan James Robert Macfarlane^{45

46}, Anthony T Machi⁴⁷, Padraig Mahon³², Stephen Mannion⁴⁸, David H McLeod⁴⁹, Peter Merjavy⁵⁰, Aleksejs Miscuks⁵¹, Christopher H Mitchell⁵², Eleni Moka⁵³, Peter Moran³⁸, Ann Ngui⁴, Olga C Nin⁵⁴, Brian D O'Donnell³², Amit Pawa^{55

56}, Anahi Perlas^{57

58}, Steven Porter⁵⁹, John-Paul Pozek⁶⁰, Humberto C Rebelo⁶¹, Vicente Roqués⁶², Kristopher M Schroeder⁶³, Gary Schwartz⁶⁴, Eric S Schwenk³, Luc Sermeus⁶⁵, George Shorten^{32

33

66}, Karthikeyan Srinivasan¹³, Markus F Stevens⁶⁷, Kassiani Theodoraki⁶⁸, Lloyd R Turbitt⁶⁹, Luis Fernando Valdés-Vilches⁷⁰, Thomas Volk^{71

72}, Katrina Webster^{73

74}, T Wiesmann^{75

76}, Sylvia H Wilson⁷⁷, Morné Wolmarans⁷⁸, Glenn Woodworth⁷⁹, Andrew K Worek⁸⁰, E M Louise Moran⁸¹

Affiliations

¹ Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
² Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland.
³ Department of Anesthesiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
⁴ Department of Anaesthesia, Fiona Stanley Hospital and Freemantle Hospitals, Perth, Western Australia, Australia.
⁵ Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
⁶ Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland.
⁷ Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
⁸ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
⁹ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA.
¹⁰ Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland.
¹¹ Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
¹² Department of Anaesthesia, Liverpool Hospital, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.
¹³ Department of Anaesthesia, Tallaght University Hospital, Dublin, Ireland.
¹⁴ Department of Anaesthesia and Pain Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
¹⁵ Faculty of Medical Sciences, Unit of Pain Research and Treatment, Medical University of Silesia, Zabrze, Poland.
¹⁶ Department of Anaesthesia, Clinique Medipole Garonne, Toulouse, France.
¹⁷ Department of Anesthesia and Intensive Care, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania.
¹⁸ Department of Anaesthesiology, Intensive Care and Pain Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
¹⁹ Department of Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
²⁰ Retired Consultant Anaesthetist, Worcester Royal Hospital, Worcester, UK.
²¹ Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland.
²² Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
²³ Department of Anesthesia, Clinique Sainte Anne Saint Remi, Bruxelles, Belgium.
²⁴ Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
²⁵ Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Turkey.
²⁶ Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
²⁷ Department of Anaesthesia, St Mary's Hospital, Imperial College, London, UK.
²⁸ Ultrasound Education Unit, University of Melbourne, Melbourne, Victoria, Australia.
²⁹ Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
³⁰ Department of Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA.
³¹ Department of Anaesthesiology and Intensive Care, F D Roosevelt Teaching Hospital, Banska Bystrica, Slovakia.
³² Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland.
³³ School of Medicine, University College Cork, Cork, Ireland.
³⁴ Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
³⁵ Department of Anesthesiology, Perioperative and Pain Medicine and Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³⁶ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³⁷ Department of Anesthesiology and Perioperative Medicine, The University of Alabama, Birmingham, Alabama, USA.
³⁸ Department of Anaesthesia, Galway University Hospitals, Galway, Ireland.
³⁹ Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁴⁰ Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
⁴¹ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA.
⁴² Department of Anesthesia and Surgical Intensive Care, Changi General Hospital, Singapore.
⁴³ Department of Anaesthesia, Hospital das Forças Armadas, Porto, Portugal.
⁴⁴ Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA.
⁴⁵ Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary, Glasgow, UK.
⁴⁶ School of Medicine, University of Glasgow, Glasgow, UK.
⁴⁷ Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴⁸ Department of Anaesthesia, South Infirmary Victoria University Hospital, Cork, Ireland.
⁴⁹ Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia.
⁵⁰ Department of Anaesthesia, Craigavon Area University Teaching Hospital, Craigavon, UK.
⁵¹ Department of Anaesthesiology, Hospital of Traumatology and Orthopaedics, University of Latvia, Riga, Latvia.
⁵² Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
⁵³ Department of Anaesthesiology, Creta InterClinic Hospital, Hellenic Healthcare Group, Heraklion-Crete, Greece.
⁵⁴ Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
⁵⁵ Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁵⁶ Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁵⁷ Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada.
⁵⁸ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵⁹ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA.
⁶⁰ Department of Anesthesiology, University of Kansas Health System, Kansas City, Kansas, USA.
⁶¹ Department of Anaesthesiology, Hospital Luz Arrábida, Vila Nova de Gaia, Portugal.
⁶² Department of Anaesthesia and Intensive Care Medicine, Virgen de la Arrixaca University Hospital, Murcia, Spain.
⁶³ Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁶⁴ Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA.
⁶⁵ Department of Anesthesia, Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium.
⁶⁶ Insight II, SFI Research Centre, Cork, Ireland.
⁶⁷ Department of Anesthesiology, Amsterdam Univeristy Medical Centers, Amsterdam, Netherlands.
⁶⁸ Department of Anesthesiology, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece.
⁶⁹ Department of Anaesthesia, Royal Victoria Hospital, Belfast, UK.
⁷⁰ Department of Anesthesiology and Reanimation, Hospital Costa del Sol, Marbella, Spain.
⁷¹ Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital, Homburg, Germany.
⁷² Faculty of Medicine, Saarland University, Homburg, Germany.
⁷³ Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁷⁴ School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁷⁵ Department of Anesthesiology & Intensive Care Medicine, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany.
⁷⁶ Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum, Schwäbisch Hall, Germany.
⁷⁷ Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷⁸ Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
⁷⁹ Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA.
⁸⁰ Post and Post LLC, Berwyn, Pennsylvania, USA.
⁸¹ Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland lmoran75@gmail.com.

PMID: 35193970
PMCID: PMC8961753
DOI: 10.1136/rapm-2021-103136

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Hassan M Ahmed et al. Reg Anesth Pain Med. 2022 May.

. 2022 May;47(5):301-308.

doi: 10.1136/rapm-2021-103136. Epub 2022 Feb 22.

Authors

Affiliations

¹ Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
² Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland.
³ Department of Anesthesiology, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA.
⁴ Department of Anaesthesia, Fiona Stanley Hospital and Freemantle Hospitals, Perth, Western Australia, Australia.
⁵ Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
⁶ Department of Anaesthesia, University Hospital of Lausanne, Lausanne, Switzerland.
⁷ Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
⁸ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
⁹ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, USA.
¹⁰ Department of Anaesthesia, Intensive Care and Pain Medicine, St Vincent's University Hospital, Dublin, Ireland.
¹¹ Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.
¹² Department of Anaesthesia, Liverpool Hospital, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.
¹³ Department of Anaesthesia, Tallaght University Hospital, Dublin, Ireland.
¹⁴ Department of Anaesthesia and Pain Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
¹⁵ Faculty of Medical Sciences, Unit of Pain Research and Treatment, Medical University of Silesia, Zabrze, Poland.
¹⁶ Department of Anaesthesia, Clinique Medipole Garonne, Toulouse, France.
¹⁷ Department of Anesthesia and Intensive Care, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania.
¹⁸ Department of Anaesthesiology, Intensive Care and Pain Medicine, National Pirogov Memorial Medical University, Vinnytsia, Ukraine.
¹⁹ Department of Anaesthesia and Pain Management, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
²⁰ Retired Consultant Anaesthetist, Worcester Royal Hospital, Worcester, UK.
²¹ Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland.
²² Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
²³ Department of Anesthesia, Clinique Sainte Anne Saint Remi, Bruxelles, Belgium.
²⁴ Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
²⁵ Department of Anesthesiology and Reanimation, Koç University Hospital, Istanbul, Turkey.
²⁶ Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
²⁷ Department of Anaesthesia, St Mary's Hospital, Imperial College, London, UK.
²⁸ Ultrasound Education Unit, University of Melbourne, Melbourne, Victoria, Australia.
²⁹ Department of Anaesthesia, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.
³⁰ Department of Anesthesiology, University of Texas McGovern Medical School, Houston, Texas, USA.
³¹ Department of Anaesthesiology and Intensive Care, F D Roosevelt Teaching Hospital, Banska Bystrica, Slovakia.
³² Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital, Cork, Ireland.
³³ School of Medicine, University College Cork, Cork, Ireland.
³⁴ Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
³⁵ Department of Anesthesiology, Perioperative and Pain Medicine and Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
³⁶ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³⁷ Department of Anesthesiology and Perioperative Medicine, The University of Alabama, Birmingham, Alabama, USA.
³⁸ Department of Anaesthesia, Galway University Hospitals, Galway, Ireland.
³⁹ Department of Anaesthesia, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
⁴⁰ Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
⁴¹ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Health Care, Stanford, California, USA.
⁴² Department of Anesthesia and Surgical Intensive Care, Changi General Hospital, Singapore.
⁴³ Department of Anaesthesia, Hospital das Forças Armadas, Porto, Portugal.
⁴⁴ Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York, USA.
⁴⁵ Department of Anaesthesia, Pain and Critical Care Medicine, Glasgow Royal Infirmary, Glasgow, UK.
⁴⁶ School of Medicine, University of Glasgow, Glasgow, UK.
⁴⁷ Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
⁴⁸ Department of Anaesthesia, South Infirmary Victoria University Hospital, Cork, Ireland.
⁴⁹ Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia, Australia.
⁵⁰ Department of Anaesthesia, Craigavon Area University Teaching Hospital, Craigavon, UK.
⁵¹ Department of Anaesthesiology, Hospital of Traumatology and Orthopaedics, University of Latvia, Riga, Latvia.
⁵² Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
⁵³ Department of Anaesthesiology, Creta InterClinic Hospital, Hellenic Healthcare Group, Heraklion-Crete, Greece.
⁵⁴ Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
⁵⁵ Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁵⁶ Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁵⁷ Department of Anesthesia and Pain Medicine, Toronto Western Hospital, Toronto, Ontario, Canada.
⁵⁸ Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
⁵⁹ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA.
⁶⁰ Department of Anesthesiology, University of Kansas Health System, Kansas City, Kansas, USA.
⁶¹ Department of Anaesthesiology, Hospital Luz Arrábida, Vila Nova de Gaia, Portugal.
⁶² Department of Anaesthesia and Intensive Care Medicine, Virgen de la Arrixaca University Hospital, Murcia, Spain.
⁶³ Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
⁶⁴ Department of Anesthesiology, Maimonides Medical Center, Brooklyn, New York, USA.
⁶⁵ Department of Anesthesia, Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium.
⁶⁶ Insight II, SFI Research Centre, Cork, Ireland.
⁶⁷ Department of Anesthesiology, Amsterdam Univeristy Medical Centers, Amsterdam, Netherlands.
⁶⁸ Department of Anesthesiology, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece.
⁶⁹ Department of Anaesthesia, Royal Victoria Hospital, Belfast, UK.
⁷⁰ Department of Anesthesiology and Reanimation, Hospital Costa del Sol, Marbella, Spain.
⁷¹ Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital, Homburg, Germany.
⁷² Faculty of Medicine, Saarland University, Homburg, Germany.
⁷³ Department of Anaesthesia and Perioperative Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.
⁷⁴ School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
⁷⁵ Department of Anesthesiology & Intensive Care Medicine, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany.
⁷⁶ Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum, Schwäbisch Hall, Germany.
⁷⁷ Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
⁷⁸ Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
⁷⁹ Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA.
⁸⁰ Post and Post LLC, Berwyn, Pennsylvania, USA.
⁸¹ Department of Anaesthesia and Intensive Care, Letterkenny University Hospital, Letterkenny, Donegal, Ireland lmoran75@gmail.com.

PMID: 35193970
PMCID: PMC8961753
DOI: 10.1136/rapm-2021-103136

Abstract

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia.

Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement.

Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29.

Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

Keywords: Delphi process; anesthesia; documentation; international consensus; minimum standards; nerve block; neuraxial; regional anesthesia.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Flowchart showing structure of Delphi process and progress of experts throughout the project.

**Figure 2**
Flowchart showing structure of Delphi process and progress of items throughout the project.

See this image and copyright information in PMC

References

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Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Affiliations

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources