A tool for sharing opinions 

Are you familiar with the Delphi method? It is a technique of investigation used in scientific research, which is carried out through several rounds based on the opinions of panel of experts, in order to bring together different ideas into a single shared expression. 

This tool was used in an Italian national project to reach a consensus on appropriateness criteria of admission to intensive rehabilitation units. 

The problem of appropriateness in rehabilitation wards 

The increase in life expectancy with comorbidity and the goal to reduce hospitalisation in acute wards are leading to the overuse of rehabilitation wards, unnecessarily increasing healthcare costs and reducing the quality of services. Moreover, in Italy each region defines autonomously the parameters with which to include or not a patient in a ward, leaving much freedom to the personal experience of clinicians and leading to inhomogeneity on the territory. 

Thanks to funds from the Italian Ministry of Health, the Emilia Romagna region has started a project to standardise the criteria by which a patient enters a rehabilitation ward. 

Hospital wards

Our first study and its limitation 

A group of Italian experts was involved in to give their opinion, thanks to the lead of Dr Rodolfo Brianti at the Azienda Ospedaliero-Universitaria di Parma and the collaboration of the University of Milan and Dr Silvana Castaldi. 

Merlo BioEngineering conducted the anonymous panel discussion using the Delphi method, coordinating the different rounds and managing the several results from the interviews of clinicians from all over Italy. 

Delphi questionnaire
Delphi questionnaire
Delphi questionnaire

After a few months of discussions, 19 appropriateness criteria and 21 inappropriateness criteria were defined for hospitalisation in orthopaedic, neurological and cardiological intensive rehabilitation, aligning the opinions of 16 experts. This result, published hererepresents the first attempt in Italy to define shared and objective appropriateness criteria for admission to intensive rehabilitation. Unfortunately, the low level of adherence and consensus on certain patient samples did not allow definitive conclusions to be drawn. 

The second study and the reaching of consensus 

The second study went different, thanks to the collaboration with SIMFER (the Italian Society of Physical Medicine and Rehabilitation), with the participation of 53 experts representing 19 Italian regions: in just three rounds, seven criteria were defined, the combination of which led to the formulation of five rules, most of which are applicable to any rehabilitation ward and no longer just to intensive care. 

The results, published on the European Journal of PRM, may pave the way for the production of official guidelines.

>>>  Have a look at the five rules for appropriateness in admission to rehabilitation!  <<<

Achieving consensus among a group of experts using the Delphi method is part of a wider project conducted in Emilia Romagna under the guidance of Dr Salvatore Ferro and Dr Rodolfo Brianti to improve the appropriateness of rehabilitation admissions, which we have discussed in a previous post.