International Journal of COPD (May 2022)

Development of an Electronic Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Proforma (E-ICP) to Improve Interdisciplinary Guideline Adherence in the Emergency Department: Modified Delphi Study

  • Issac H,
  • Keijzers G,
  • Yang IA,
  • Lea J,
  • Taylor M,
  • Moloney C

Journal volume & issue
Vol. Volume 17
pp. 1089 – 1106

Abstract

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Hancy Issac,1,2 Gerben Keijzers,3– 5 Ian A Yang,6,7 Jackie Lea,1,2 Melissa Taylor,1,2 Clint Moloney1,8,9 1School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia; 2Centre of Health Research, University of Southern Queensland, Toowoomba, QLD, Australia; 3Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, QLD, Australia; 4Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia; 5School of Medicine, Griffith University, Gold Coast, QLD, Australia; 6Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia; 7Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 8College of Health and Biomedicine, Nursing and Midwifery, Victoria University, Melbourne, VIC, Australia; 9Institute for Health and Sport, Victoria University, Melbourne, VIC, AustraliaCorrespondence: Hancy Issac, School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, QLD, Australia, Email [email protected]: Chronic obstructive pulmonary disease guideline non-adherence is associated with a reduction in health-related quality of life in patients (HRQoL). Improving guideline adherence has the potential to mitigate fragmented care thereby sustaining pulmonary function, preventing acute exacerbations, reducing economic health burdens, and enhancing HRQoL. The development of an electronic proforma stemming from expert consensus, including digital guideline resources and direct interdisciplinary referrals is hypothesised to improve guideline adherence and patient outcomes for emergency department (ED) patients with COPD.Aim: The aim of this study was to develop consensus among ED and respiratory staff for the correct composition of a COPD electronic proforma that aids in guideline adherence and management in the ED.Methods: This study adopted a mixed-method design to develop the most important indicators of care in the ED. The study involved three phases: (1) a systematic literature review and qualitative interdisciplinary staff interviews to assess barriers and solutions for guideline adherence and qualitative interdisciplinary staff interviews, (2) a modified Delphi panel to select interventions for the proforma, and (3) a consensus process through three rounds of scoring through a quantitative survey (ED and Respiratory consensus) and qualitative thematic analysis on each indicator.Results: The electronic proforma achieved acceptable and good internal consistency through all iterations from national emergency department and respiratory department interdisciplinary experts. Cronbach’s alpha score for internal consistency (α) in iteration 1 emergency department cohort (EDC) (α = 0.80 [CI = 0.89%]), respiratory department cohort (RDC) (α = 0.95 [CI = 0.98%]). Iteration 2 reported EDC (α = 0.85 [CI = 0.97%]) and RDC (α = 0.86 [CI = 0.97%]). Iteration 3 revealed EDC (α = 0.73 [CI = 0.91%]) and RDC (α = 0.86 [CI = 0.95%]), respectively.Conclusion: Electronic proformas have the potential to facilitate direct referrals from the ED leading to reduced hospital admissions, reduced length of hospital stays, holistic care, improved health care and quality of life and improved interdisciplinary guideline adherence.Keywords: COPD, electronic proforma, modified Delphi study, interdisciplinary, guideline adherence, COPD-X plan

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