RESEARCH ARTICLE Open Access Applying real-time Delphi methods: development of a pain management survey in emergency nursing Wayne Varndell 1,2,3* , Margaret Fry 4,5 and Doug Elliott 4 Abstract The modified Delphi technique is widely used to develop consensus on group opinion within health services research. However, digital platforms are offering researchers the capacity to undertake a real-time Delphi, which provides novel opportunities to enhance the process. The aim of this case study is to discuss and reflect on the use of a real-time Delphi method for researchers in emergency nursing and cognate areas of practice. A real-time Delphi method was used to develop a national survey examining knowledge, perceptions and factors influencing pain assessment and management practices among Australian emergency nurses. While designing and completing this real-time Delphi study, a number of areas, emerged that demanded careful consideration and provide guidance to future researchers. Keywords: Delphi, Methodology, Consensus, Emergency Nursing, Group Opinion Background The Delphi technique is an established and effective re- search method with multifaceted applications for health services research. The Delphi technique is uniquely de- signed to explore health issues and topics where minimal information or agreement currently exists, a relatively common situation within nursing practice. Secondly, the Delphi technique allows for the introduction and inte- gration of viewpoints, opinions, and insights from a wide array of expert stakeholders. With increasing accessibil- ity to the Internet and proliferation of smart device tech- nology, changes from paper-based surveys to the development of online software systems, such as the real-time Delphi method, has significantly extended the potential research for the research population and sam- ple, and efficiency of data collection and analysis. However, a recent systematic review highlighted a gap between available methodological guidance and publish- ing primary research in conducting real-time Delphi studies [1, 2]. In this paper, we seek to examine the methodological gap in applying real-time Delphi methods, by providing a specific case example from a real-time Delphi study conducted to develop a self-reporting survey tool to ex- plore pain management practices of Australian emer- gency nursing in critically ill adult patients [3]. Insight into the procedural challenges and enablers encountered in conducting a real-time Delphi study are provided. Im- portantly, key characteristics of the method are pre- sented, followed by the case-based exemplars to illustrate important methodological considerations. Re- flections from the case are then presented, along with recommendations for future researchers considering the use of a real-time Delphi technique approach. © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. * Correspondence: wayne.varndell@uts.edu.au 1 Prince of Wales Hospital Emergency Department, NSW 2031 Randwick, Australia 2 Faculty of Health, University of Technology Sydney, NSW 2007 Ultimo, Australia Full list of author information is available at the end of the article Varndell et al. BMC Nursing (2021) 20:149 https://doi.org/10.1186/s12912-021-00661-9