PONE-D-24-25666Validating Quality Standards in Palestinian Emergency Departments: An e-Delphi Survey ApproachPLOS ONE

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Additional Editor Comments:

The manuscript has a good deal of merit for publication but needs minor revisions to further improve its quality and impact.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for providing me the opportunity to review the manuscript entitled “Validating Quality Standards in Palestinian Emergency Departments: An e-Delphi Survey Approach” by Alr’oof Bani Odeh et al. The approach taken to validate quality standards within Palestinian emergency healthcare settings was crucial. The authors laid a strong foundation for future assessments and the implementation of improved service standards. With the involvement of a diverse panel of experts, the study effectively aimed at achieving consensus through a thorough examination of clinical and administrative domains. This comprehensive evaluation affirmed the robustness of the Emergency Department Quality Standards (EDQS).

While the manuscript fulfils its objective of laying the groundwork for assessing and validating quality standards in Palestinian Emergency Departments, I would like to offer a few minor recommendations that may further enhance the clarity and flow of your work:

1. Introduction (Elaboration on Previous Shortcomings in Literature): It would be beneficial to elaborate on the shortcomings of past researches in their attempts to better elucidate on the gap bridged by the study. ‘Unlike traditional methods of setting quality standards ..’ This statement may be supported by highlighting such previous orthodox methodologies adopted, allowing the study’s innovations to stand out more clearly. Kindly consider this addition under the introduction.

2. Methods:

a. Delphi panel recruitment and sample: In the sentence “In the two rounds only 53... and too long a survey to complete,” it is implied that the length of the survey may have introduced bias. Could you kindly elaborate on the measures taken to ensure that participants who completed the survey were not influenced by the survey's length, and how potential bias was mitigated?

b. Readability, clarity and comprehensiveness: It is recommended to provide further details on the sources utilized for determining these as the three key validation criteria. This will enhance understanding of the criteria selection and strengthen the study's methodological transparency.

c. Delphi rounds (Subheading – Round 1 Evaluation and Shortlisting) : In the line “…with consensus threshold defined at ≥ 80% agreement and IQR ≤ 1,” I suggest elaborating on the tool, instrument, or method used to determine these thresholds. Providing this additional information would aid in further validating the standards used to analyze the findings.

3. Discussion (Literature comparison): While the approach is novel it is advisable to further support your findings by comparing them to existing or past research under discussion. The authors note that "the progress of its development is still in its nascent phase" and that the research "aligns with existing literature on EDQS in several ways." By citing relevant previous studies, the authors can strengthen their arguments, provide clearer context, and reinforce the credibility of their findings. Additionally, the statement "The research aligns with ongoing healthcare system enhancements" would benefit from further elaboration, highlighting how the study contributes to current advancements in the field.

4. Literature Review sources as the Foundation of the Validation Process: The literature review serves as a critical foundation for the development of the quality standards being validated. It has been noted that "these standards were compiled through a combination of literature review" and that "the EDQS subjected to validation were previously identified through a literature review." To strengthen this validation process, it is recommended to provide specific examples of previous research that informed the standards. This would not only support the process but also clarify the criteria for selection.

5. Formatting Adjustments: To improve the professional presentation of the manuscript, I suggest the following formatting adjustments:

a. Including line numbers would facilitate easier referencing for both the author and reviewer, and using "Page X of Y" for page numbering would enhance organization and navigation.

b. Additionally, please maintain font size consistency, as the font size under the subheading “Consensus Achievement” appears to decrease from 11 to 10 in the line referencing “workforce staffing and training subdomain.” Consistent font size will aid in readability.

c. It is recommended to rename the "Background" section to "Introduction" to more accurately reflect its content. The title "Introduction" better captures the broader elements discussed, such as research gaps, objectives, and global impact, as opposed to the historical context implied by "Background."

Reviewer #2: Abstract Is too long especially methodology and conclusion

Give more idea about previously Palestine's derived emergency department quality standards in introduction

Real Trauma quality standards have no space in this eDelphi survey which should have been priority

Better is results in place of findings.

103 quality standards specific to Palestinian EDs were too excess, should have evalusated less nimber , yield would have been more prosperous and cutting edge research.

You have done eDelphi survey, need to know what new learning from your survey is for the Palestine.

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Reviewer #1: No

Reviewer #2: No

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Validating quality standards in Palestinian emergency departments: an e-Delphi survey approach

PONE-D-24-25666R1

Dear Dr. Abed Alra'oof Saleem Bani Odeh,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Naeem Mubarak, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have convincingly addressed all the comments. No further changes are needed. Best of luck with your publication

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All the comments have been addressed by the authors, and I have no further suggestions to make. The modifications introduced are commendable, as they enhance clarity, address prior limitations, and provide thorough elaboration while acknowledging previous findings. The authors have demonstrated significant dedication to addressing feedback, particularly in advancing the objective of validating Emergency Department Quality Standards (EDQS) in Palestine using a unique approach.

Reviewer #2: The comments have been responded well to reach standard of worth of Publishing in PLOS One. The study is going to improve quality standards in Palestinian emergency departments

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Imtiaz Wani

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