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Consensus Reached on Checklist for Operative Notes Following Pediatric Microlaryngoscopy and Bronchoscopy

by Linda Kossoff •

What do pediatric otolaryngologists who are bronchoscopy experts cite as the most critical components of a surgeon’s operative notes following pediatric microlaryngoscopy and bronchoscopy (MLB)?

BOTTOM LINE

Experts reached consensus on a checklist that includes breathing description, airway views grade, normal anatomic structure description, subglottic stenosis grade, presence/description of tracheobronchomalacia, and presence of fistulae, cleft and rings.

BACKGROUND: Microlaryngoscopy and bronchoscopy is a commonly performed procedure in pediatric otolaryngology–head and neck surgery. A complete, accurate postprocedural operative note detailing important findings and key steps of MLB is vital for future patient care. There is, however, currently no standard content required for documentation in pediatric MLB.

STUDY DESIGN: Survey research.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Schulich School of Medicine and Dentistry, London, Ontario, Canada.

SYNOPSIS: Researchers developed a pediatric MLB checklist according to a previously described modified blinded Delphi Consensus Process, which they distributed as a survey to expert pediatric airway surgeons across six countries. In round one, 74 identified experts were invited to rate 100 checklist items as “keep” or “remove” and to comment on/suggest changes for each item. Thirty- eight experts (51.4%) responded. A revised, 78-item list was then distributed to the original 74 experts, asking to rate each item on a 7-point Likert scale. Thirty-six experts responded (48.6% response rate). Mean scores were calculated and items were categorized as “reached consensus” (28 items, which became the final checklist), “near consensus” (24 items), or “no consensus” (26 items). Experts reached consensus on items such as “name of procedure” and “description of breathing,” but not on identification of equipment used, description of the flow of the procedure, and photodocumentation, potentially due to institution-related variables such as record-keeping protocols, differences in terminology, and available resources. Study limitations included the subjective nature of Delphi consensus.

CITATION: Neocleous P, Dzioba A, Strychowsky J, et al. Documentation in pediatric microlaryngoscopy/bronchoscopy: international modified Delphi consensus. Laryngoscope. 2023;133:1234–1238.