title: Establishing nursing-sensitive quality indicators for the operating room: A cross-sectional Delphi survey conducted in China.
abstract: BACKGROUND
  Nursing-sensitive quality indicators comprise principles, procedures, and assessments to quantify the level of nursing quality in hospital departments. Although studies have demonstrated that quality indicators are essential for monitoring nursing practice in the operating room (OR), nursing quality in China is highly subjective and localised OR nursing-sensitive quality indicators are lacking.
  
  
  OBJECTIVE
  This study aimed to establish scientific, objective and comprehensive nursing-sensitive quality indicators for the OR to evaluate and monitor OR nursing care quality in China.
  
  
  METHODS
  Literature search for relevant evidence-based studies was performed using Cochrane, Medline, PubMed, Embase, and other databases, followed by literature review and group discussion by the expert panel. Two successive rounds of Delphi surveys were conducted using questionnaires completed by the expert panel to reach consensus and define nursing-sensitive quality indicators for the OR.
  
  
  RESULTS
  Two rounds of Delphi surveys each had 100% questionnaire retrieval rate, with Kendall W coordination coefficients ranging from 0.096 to 0.263 (P<0.001). In round 1 of expert evaluation of 26 indicators, Kendall's W was 0.263 for importance, 0.126 for rationality, and 0.125 for feasibility of data collection (all P<0.001). After round 2, 23 items were established as OR nursing-sensitive quality indicators, including rates of work time wastage, surgery start-time delay, OR turnover time between surgeries, same-day surgery cancellation, and number of monthly surgeries in each OR; checking surgical patients, surgery site marking, allergy history, and antibiotics use 60min before incision; and also assessing expected surgical time, sterilisation indicator results, availability of surgical instruments and materials, and instrument count.
  
  
  CONCLUSIONS
  Scientific, practical, and reliable OR nursing-sensitive quality indicators can be established based on evidence-based studies and expert consensus using the Delphi method. The quality indicators developed in this study may provide an objective and quantitative reference for evaluating nursing quality in Chinese ORs.
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China; Operating Room, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China. Electronic address: 982985630@qq.com.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Huang
authors.affiliation: Library, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Mei-Yuan
authors.initials: MY
authors.lastname: Xing
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Zhi-Xian
authors.initials: ZX
authors.lastname: Feng
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Le-Wen
authors.initials: LW
authors.lastname: Shao
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Mei-Yun
authors.initials: MY
authors.lastname: Zhang
authors.affiliation: Department of Nursing, The First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang Province, China.
authors.forename: Rong-Ya
authors.initials: RY
authors.lastname: Shao
mesh_terms: D002681:China; D003697:Delphi Technique; D055318:Evidence-Based Nursing; D006801:Humans; D009871:Operating Room Nursing; D009873:Operating Rooms; D019984:Quality Indicators, Health Care
keywords: Delphi method; Evidence-based; Expert panel; Nursing-sensitive quality indicators; Operating room