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

Abstract

IntroductionThe ability of standard operating procedures to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect on pre-hospital critical care anaesthesiologists’ behaviour of implementing a standard operating procedure for pre-hospital controlled ventilation.Materials and methodsAnaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data according to the Utstein-style template. We collected pre-intervention data from February 1st 2011 to January 31st 2012, implemented the standard operating procedure on February 1st 2012 and collected post intervention data from February 1st 2012 until October 31st 2012. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. The objective was to evaluate whether the development and implementation of a standard operating procedure for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists’ behaviour and thereby increase the use of automated ventilators in these patients.ResultsThe implementation of a standard operating procedure increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 (0.34-0.47) to 0.74 (0.69-0.80) with a prevalence ratio of 1.85 (1.57-2.19) (p = 0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 (0.26-0.62) to 0.85 (0.62-0.97) with a prevalence ratio of 1.94 (1.26-3.0) (p = 0.0039). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 (0.26-0.48) to 0.69 (0.58-0.78) with a prevalence ratio of 1.79 (1.36-2.35) (p = 0.00).ConclusionWe have shown that the implementation of a standard operating procedure for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists’ behaviour.

Tip to Hub Vertical Recapping an Alternative Method to One Hand Recapping Technique.

“…Standard Operative Procedure(SOP) is useful in healthcare by reducing the errors in the procedure and for better results [13][14][15][16].…”

Airway management in pre-hospital critical care: a review of the evidence for a ‘top five’ research priority

“…Otherwise meticulous attention should be paid to performing high-quality basic airway interventions [ 50 , 52 , 58 , 59 ]. Studies which have reviewed the implementation and effectiveness of these tools within pre-hospital services have been able to demonstrate uncomplicated introduction process [ 60 ] and improvement in compliance with guideline standards [ 61 , 62 ].…”

“…Mechanical ventilation is generally considered to be superior to hand ventilation when targeting a specific range for end-tidal carbon dioxide [ 71 ]. One Scandinavian service demonstrated increased use of mechanical ventilation following the introduction of an standard operating procedure [ 62 ].…”

“…Body temperature should be maintained in the pre-hospital setting. Recent data has demonstrated a higher rate of hypothermia in patients who are anaesthetised outside hospital [ 62 ]. Previously cooling patients with traumatic brain injury or post cardiac arrest was considered to be beneficial to outcome but subsequent studies have questioned this theory and it is no longer recommended practice [ 72 , 73 ].…”

A standardised approach to pre-hospital RSI in the UK; utility, governance and content of current pre-induction checklists

“…Pre-hospital Rapid Sequence Induction (RSI) is often performed on patients nearing physiological exhaustion in a complex, challenging environment [ 1 ]. Standard Operating Procedures (SOPs) and checklists can be used to improve patient safety [ 2 ]. The UK incidence of pre-hospital RSI and the utility and content of these safety constructs are unknown.…”