Integrating real-time polling into modified Delphi methodology: lessons from a consensus study on cardiac implantable electronic device remote monitoring

The Delphi technique is widely used to develop consensus among experts, particularly in clinical guideline development. However, traditional Delphi methods can be time-consuming, resource-intensive, and challenging to implement across geographically dispersed regions. This study presents a novel adaptation of the modified Delphi method using real-time polling software to enhance efficiency, engagement, and consensus-building. We conducted a four-round modified Delphi study involving clinicians across Australia and New Zealand. Real-time polling software (Mentimeter) was integrated into two rounds, enabling anonymous voting, immediate display of aggregated results, and iterative discussion during hybrid meetings. The method was applied to develop clinical appropriateness recommendations for remote monitoring of cardiac implantable electronic devices (CIEDs), serving as an exemplar for broader methodological innovation. Fifty-seven participants completed Round 1, with sustained engagement across subsequent rounds. Real-time polling facilitated consensus on multiple recommendations within a single session, reducing study duration and enhancing participant interaction. Anonymity was preserved throughout, and geographic barriers were mitigated through hybrid participation. The approach enabled efficient refinement of recommendations and supported broad expert input. This study demonstrates the feasibility and value of integrating real-time polling platforms into modified Delphi studies. The method offers a scalable, cost-effective, and accessible alternative to traditional approaches, particularly suited to time-sensitive research and geographically dispersed panels.