Development of consensus-based standards for a National Clinical Audit of Perioperative Care: protocol for a modified Delphi consensus study

Introduction

Variation in perioperative care delivery and outcomes persists across healthcare systems, contributing to differences in patient experience, efficiency and outcomes. National clinical audits play a central role in benchmarking practice and supporting quality improvement. However, there is currently no unified, consensus-derived set of standards to underpin a comprehensive national audit of perioperative care across specialties in the UK. This proposed modified Delphi will develop a core set of standards to support benchmarking for the newly commissioned National Clinical Audit of Perioperative Care (NCAPC), aiming to reduce unwarranted variation and inform system-wide improvement in perioperative care.

Methods and analyses

A rapid literature review has been undertaken to inform the identification of existing frameworks, standards and areas of variation from academic and grey literature, including National Health Service (NHS) and policy guidelines. Candidate standards have been refined through a quality standard mapping exercise by a multidisciplinary expert Clinical Reference Group, including patient representatives. Derived quality standards will be put forward for a multiround, national, web-based modified Delphi process that will be used to develop consensus-based perioperative audit standards. The Delphi will be conducted with two stakeholder panels: healthcare professionals involved in perioperative care and patients with lived experience of major surgery. Participants will rate standards using a 9-point Likert scale across at least two rounds. Predefined consensus criteria will determine progression and inclusion. A subsequent consensus meeting and expert Clinical Reference Group panel will refine and operationalise the final standards. Quantitative data will be summarised descriptively, with consensus defined using a priori thresholds applied separately to stakeholder groups. Standards meeting consensus criteria will be prioritised based on high-importance ratings and aggregated across panels. Qualitative data will undergo inductive thematic analysis to inform iterative refinement. The final output will be a stakeholder-informed, consensus-derived set of measurable perioperative audit standards for national implementation within the English NHS.

Ethics and dissemination

This study has been approved by the Faculty Research Ethics Committee at the University of Southampton (ERGO110645). Findings will be disseminated through peer-reviewed publications and presentations at national and international conferences. The final consensus-derived standards will be shared with key stakeholders, including the Royal Colleges and NHS England, to support implementation of the NCAPC that will impact NHS-wide perioperative medicine practice. Lay summaries will be developed with patient representatives to ensure accessible communication to the public.

Trial registration number

This study has been prospectively registered with the Core Outcome Measures in Effectiveness trials (COMET) Initiative (registration number 3886—https://www.comet-initiative.org/Studies/Details/3886).