title: A modified Delphi process to identify process of care indicators for the identification, prevention and management of acute kidney injury after major surgery.
abstract: BACKGROUND
  The outcomes of acute kidney injury (AKI) are well appreciated. However, valid indicators of high quality processes of care for AKI after major surgery are lacking.
  
  
  OBJECTIVE
  To identify indicators of high quality processes of care related to AKI prevention, identification, and management after major surgery.
  
  
  METHODS
  A three stage modified Delphi process.
  
  
  METHODS
  The study was conducted in Alberta, Canada using an online format.
  
  
  METHODS
  A panel of care providers from surgery, critical care, and nephrology.
  
  
  METHODS
  The degree of validity of candidate indicators were rated by panelists on a 7-point Likert scale that ranged from "strongly disagree" to "strongly agree".
  
  
  METHODS
  A focused literature review was performed to identify candidate indicators. A modified Delphi process, with three rounds, was used to obtain expert consensus on the validity of potential process of care quality indicators.
  
  
  RESULTS
  Thirty-three physicians participated (6 from surgery, 10 from critical care, and 17 from nephrology). A list of 58 potential process of care quality indicators for AKI after surgery was generated including 28 indicators from the initial literature review and 30 indicators suggested by panelists. Following the third round of questioning, 40 process of care indicators were identified with a high level of agreement for face validity; 16 of these reached high consensus among all panelists.
  
  
  CONCLUSIONS
  The consensus of panelists from Alberta, Canada may not be generalizable to other settings. The modified Delphi process did not focus on the feasibility of measuring these process indicators.
  
  
  CONCLUSIONS
  These indicators can be used to measure and improve the quality of care for AKI after major surgery.
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Canada ; Division of Nephrology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, T2N 2 T9 AB Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Neesh
authors.initials: N
authors.lastname: Pannu
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Barry
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Divya
authors.initials: D
authors.lastname: Karsanji
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada.
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Canada ; Department of Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Department of Critical Care, University of Alberta, Edmonton, Canada.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.affiliation: Department of Critical Care, University of Calgary, Calgary, Canada.
authors.forename: H Tom
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
keywords: Acute kidney injury; Quality indicators; Surgery