Key result
A systematic review of 63 articles found that reporting of local consensus discussions varied substantially, but identified four consistent elements defining a structured process for their use.
Why the study?
The study was conducted to identify and understand the different approaches to local consensus discussions used to implement perioperative pathways for common elective surgeries.
Systematic Review (n=63)
Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care, with four core elements defining a structured process.
Local consensus discussions may aid perioperative pathway implementation to reduce care variation; leaves open optimal methods and effectiveness.
AIMS: To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries. DESIGN: Systematic review. DATA SOURCES: Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023. METHODS: Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions. RESULTS: The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions. CONCLUSIONS: Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals. IMPACT: These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives. REPORTING METHOD: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution. TRIAL REGISTRATION: CRD42023413817.
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Pagano et al. (2024) conducted a systematic review in Perioperative care pathways in common elective surgeries (n=63). Local consensus discussions was evaluated on Core elements of local consensus discussions. A systematic review of 63 articles found that reporting of local consensus discussions varied substantially, but identified four consistent elements defining a structured process for their use.
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