A Qualitative Study to Understand Barriers to Implementation of National Guidelines for Prehospital Termination of Unsuccessful Resuscitation Efforts

Sasson, Comilla; Forman, Jane; Krass, David; Macy, Michelle L.; Hegg, A. J.; McNally, Bryan; Kellermann, Arthur L.

doi:10.3109/10903120903572327

Cited by 33 publications

(20 citation statements)

References 30 publications

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“…26–28 Researchers have used qualitative methods to identify factors that influence integration, implementation, and maintenance of clinical protocols among ED personnel. 29–31 In this study, we used these methods to conduct semi-structured, focused interviews of nurses and attending physicians to assess their views on integrating tobacco screening and treatment interventions into the pediatric emergency department.…”

Section: Methodsmentioning

confidence: 99%

Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes, Perceived Barriers, and Suggestions for Implementation and Maintenance

Mahabee‐Gittens

Dixon

Vaughn

et al. 2014

Journal of Emergency Nursing

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Objective The pediatric emergency department (PED) is a venue that underutilizes parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners’ attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, and to solicit suggestions for improving the sustainability and maintenance of such practices. Methods We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice. Results Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing “pre-arranged” counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (e.g., changes in children’s secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of on-site tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, and the importance of intervention “champions” in the PED. Conclusions By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.

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Section: Methodsmentioning

confidence: 99%

Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes, Perceived Barriers, and Suggestions for Implementation and Maintenance

Mahabee‐Gittens

Dixon

Vaughn

et al. 2014

Journal of Emergency Nursing

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“…In most studies, the prognosis of patients with OHCA is extremely poor. 16,17 Recently, Gueugniaud et al 18 reported a very low hospital survival rate in a French cohort of patients with cardiac arrest included in randomized study. Because there is a marked variability between hospitals in the rate of survival among patients who were alive on hospital admission after an OHCA, one possible contributory factor could be the standard of postresuscitation care.…”

Section: Discussionmentioning

confidence: 99%

Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest

Dumas

Cariou

Manzo-Silberman

et al. 2010

Circ: Cardiovascular Interventions

639

374

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Background-Acute coronary occlusion is the leading cause of cardiac arrest. Because of limited data, the indications and timing of coronary angiography and angioplasty in patients with out-of-hospital cardiac arrest are controversial. Using data from the Parisian Region Out of hospital Cardiac ArresT prospective registry, we performed an analysis to assess the effect of an invasive strategy on hospital survival. Methods and Results-Between January 2003 and December 2008, 714 patients with out-of-hospital cardiac arrest were referred to a tertiary center in Paris, France. In 435 patients with no obvious extracardiac cause of arrest, an immediate coronary angiogram was performed at admission followed, if indicated, by coronary angioplasty. At least 1 significant coronary artery lesion was found in 304 (70%) patients, in 128 (96%) of 134 patients with ST-segment elevation on the ECG performed after the return of spontaneous circulation, and in 176 (58%) of 301 patients without ST-segment elevation. The hospital survival rate was 40%. Multivariable analysis showed successful coronary angioplasty to be an independent predictive factor of survival, regardless of the postresuscitation ECG pattern (odds ratio, 2.06; 95% CI, 1.16 to 3.66). Conclusions-Successful

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“…10,11 Many EMS systems continue to employ non-validated measures such as the absence of a prehospital ROSC alone or a predefined duration of CPR to stop resuscitation in the field. Reliance on these un-tested measures to predict futility risks premature termination of resuscitation in patients who could potentially survive.…”

Section: Introductionmentioning

confidence: 99%

A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest

et al. 2017

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Introduction The Universal Termination of Resuscitation (TOR) Guideline accurately identifies potential out-of-hospital cardiac arrest (OHCA) survivors. However, implementation is inconsistent with some emergency medical service (EMS) agencies using absence of return of spontaneous circulation (ROSC) as sole criterion for termination. Objective To compare the performance of the Universal TOR Guideline with the single criterion of no prehospital ROSC. Second, to determine factors associated with survival for patients transported without a ROSC. Lastly, to compare the impact of time to ROSC as a marker of futility to the Universal TOR Guideline. Design Retrospective, observational cohort study Participants Non-traumatic, adult (≥18 years) OHCA patients of presumed cardiac etiology treated by EMS providers Setting ROC-PRIMED and ROC-Epistry post ROC-PRIMED databases between 2007 and 2011. Outcomes Primary outcome was survival to hospital discharge and the secondary outcome was functional survival. We used multivariable regression to evaluate factors associated with survival in patients transported without a ROSC. Results 36,543 treated OHCAs occurred of which 9,467 (26%) were transported to hospital without a ROSC. Patients transported without a ROSC who met the Universal TOR Guideline for transport had a survival of 3.0% (95% CI 2.5%–3.4%) compared to 0.7% (95% CI 0.4%–0.9%) in patients who met the Universal TOR Guideline for termination. The Universal TOR Guideline identified 99% of survivors requiring continued resuscitation and transportation to hospital including early identification of survivors who sustained a ROSC after extended durations of CPR. Conclusion Using absence of ROSC as a sole predictor of futility misses potential survivors. The Universal TOR Guideline remains a strong predictor of survival.

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A Qualitative Study to Understand Barriers to Implementation of National Guidelines for Prehospital Termination of Unsuccessful Resuscitation Efforts

Abstract: We have identified operational barriers that may impede implementation of TOR guidelines. Three influential stakeholder groups will need to work with national organizations to overcome these local barriers.

Cited by 33 publications

References 30 publications

Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes, Perceived Barriers, and Suggestions for Implementation and Maintenance

Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes, Perceived Barriers, and Suggestions for Implementation and Maintenance

Immediate Percutaneous Coronary Intervention Is Associated With Better Survival After Out-of-Hospital Cardiac Arrest

A comparison of the universal TOR Guideline to the absence of prehospital ROSC and duration of resuscitation in predicting futility from out-of-hospital cardiac arrest

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