A Delphi Process to Determine the Bellwether Procedures for Trauma Systems Globally: A Study Protocol

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Abstract Introduction Traumatic injuries are responsible for a huge amount of mortality, morbidity, and disability globally. Within global surgery, Bellwether procedures have previously been identified to measure the surgical proficiency of a hospital or a region, however traumatic injuries often have distinct epidemiological and demographic patterns, compared to routine surgical care. Using a focused set of procedures or processes to measure trauma performance could allow for improved trauma assessments and outcomes on a global scale. Methodology An international Delphi study will be conducted in attempt gain consensus on the optimal procedures and processes that can be used to assess the performance of trauma care within any region or hospital worldwide. Recognised guidelines for conducting the Delphi process will be followed, comprising of 3 separate rounds and participation from a public and patient involvement (PPI) group. Respondents will be identified through pre-existing collaborative networks and research partners, to ensure adequate global representation from across the trauma care pathway. The final Bellwether procedures will be those that have shown consensus in agreement and in stability throughout successive rounds Discussion This Delphi process aims to identify the optimal Bellwether metrics that could be used to assess trauma care worldwide. Using a focused set of procedures or processes to assess trauma performance globally will reduce complexity and improve ease of use compared to current methods.

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