A content‐validated framework for a patient blood management toolkit for South Africa: A mixed‐methods e ‐Delphi study

Background and Objectives South African hospitals face a high anaemia burden, variable access to patient blood management (PBM) modalities and uneven adoption of evidence‐informed transfusion practice. Pragmatic, context‐appropriate tools are needed to standardise practice and support implementation. Materials and Methods We conducted semi‐structured interviews with PBM champions ( n = 16, across six provinces in South Africa) to generate candidate toolkit items, then validated these via a three‐round e‐Delphi with a panel of 11 subject experts. Items were rated on a 3‐point Likert scale (1 = Essential; 2 = Useful; 3 = Unnecessary). Consensus was defined as ≥80% of the panel selecting the same option. Stability was defined as ≤20% (two or fewer) panellists who changed their response by Round 3. Results Round 1 included 793 statements; consensus was reached on 49.1% of items. Round 2 presented 400 non‐consensus statements remaining after Round 1, and an additional set reached consensus, raising the cumulative total to 72.5%. Round 3 included 214 statements; by the end of Round 3, cumulative consensus was 88.1%. A further 10.8% of items met the predefined stability criterion without reaching consensus. Only eight items were unresolved. Conclusion This mixed‐methods process yielded a context‐aware PBM toolkit framework for South Africa. It prioritises pre‐operative anaemia optimisation, restrictive transfusion practice, standardised peri‐operative haemorrhage protocols, fit‐for‐purpose education and practical monitoring and accountability tools with clear ownership.