Adherence to Guideline-Based Standard Operating Procedures in Pre-Hospital Emergency Patients with Chronic Obstructive Pulmonary Disease

Abstract

This study investigated improvements in pre-hospital care for patients with acute exacerbated chronic obstructive pulmonary disease (aeCOPD) achieved by using a standard operating procedure (SOP). An SOP for pre-hospital treatment of patients with aeCOPD was designed based on valid national guidelines. A total of 1000 Emergency Medical Service patient care reports were analysed prospectively: 500 before and 500 after introduction of the SOP. Overall guideline adherence was 34.6% before and 53.8% after introduction of the SOP; this increase was not statistically significant. After SOP introduction, the administration of β2-mimetics by inhalative, intravenous and subcutaneous routes increased significantly. The level of knowledge of the national guidelines was rated at 67% by emergency physicians during self-assessment, but was only 33% when physicians were asked specific questions during interview. Introducing the SOP for patients with aeCOPD did not significantly improve adherence to valid national guidelines, but did help to improve specific elements of therapy.

Standard operating procedure changed pre-hospital critical care anaesthesiologists’ behaviour: a quality control study

“…Our result compares favourably to those found by Bosse et al [5] and Francis et al [6] from the physician-staffed EMS in Berlin. They investigated the impact of introducing SOPs for the pre-hospital treatment of acute exacerbation in COPD [5] and acute coronary syndrome (ACS) [6] and neither of the SOPs in these studies improved overall patient care. The authors introduced the SOPs by arranging staff meetings and distributing the SOP by e-mail and in paper copies.…”

“…The ability of SOPs to improve physician-provided pre-hospital care is however still uncertain. Bosse et al showed that implementing an SOP for the pre-hospital treatment of severe exacerbation in chronic obstructive pulmonary disease in a physician-staffed EMS in Berlin did not improve overall guideline adherence [5]. Francis et al demonstrated that implementing an SOP for the pre-hospital treatment of acute coronary syndrome in the same physician-staffed EMS in Berlin improved some aspects of patient care, whereas other aspects were not affected [6].…”

Refraining from pre-hospital advanced airway management: a prospective observational study of critical decision making in an anaesthesiologist-staffed pre-hospital critical care service

“…Further studies are required to gain more knowledge into the critical decision making process involved in PHAAM and especially to establish whether introducing SOPs and checklists in physician-staffed pre-hospital systems can reduce the incidence of complications and ultimately improve patient safety and outcome [22]. One may speculate that our system based on experienced anaesthesiologists working as pre-hospital critical care physicians would benefit from the implementation of SOPs and checklists for PHAAM.…”

Prehospital Triage of Injured Older Adults: Thinking Slow Inside the Golden Hour

“…Similarly, in North Carolina, which has no age‐specific criteria, age was found to have almost no effect on transport rates after motor vehicle collision, even after adjusting for markers of serious injury available at the time of field triage . Nonadherence to EMS protocols has also been described for a range of other conditions, including stroke, ST elevation myocardial infarction, and chronic obstructive pulmonary disease . Although there are characteristics unique to the challenge of identifying injured older adults, the disconnect between prehospital provider protocols and practice that Caterino and colleagues observed is not limited to this task.…”

“…11 Nonadherence to EMS protocols has also been described for a range of other conditions, including stroke, ST elevation myocardial infarction, and chronic obstructive pulmonary disease. [12][13][14] Although there are characteristics unique to the challenge of identifying injured older adults, the disconnect between prehospital provider protocols and practice that Caterino and colleagues observed is not limited to this task. The characterization of intuitive and deliberate thinking by Daniel Kahneman 15 provides a framework for dissecting this problem.…”