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

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Else Tønnesen³  Hans Kirkegaard¹  Troels Martin Hansen²  Leif Rognås² 

[1] Centre for Emergency Medicine Research, Aarhus University Hospital, Trøjborgvej 72-74, Building 30, Aarhus N, 8200 Denmark;Department of Pre-hospital Medical Services, Central Denmark Region, Oluf Palmes Allé 34, Aarhus N, 8200 Denmark;Department of Anaesthesiology, Aarhus University Hospital, Nørrebrogade 44, Aarhus, 8000 Denmark

关键词: Patient safety;    Endotracheal intubation (MeSH);    Airway management (MeSH);    Standard operating procedure;    Controlled ventilation;    Critical care (MeSH);    Helicopter emergency medical service;    Emergency medical services (MeSH);    Prehospital emergency care (MeSH);    Out-of-hospital;    Pre-hospital;   

Others  :  810555
DOI  :  10.1186/1757-7241-21-84

 received in 2013-09-03, accepted in 2013-11-27,  发布年份 2013

【 摘 要 】

Introduction

The 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 methods

Anaesthesiologists 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 1^st 2011 to January 31^st 2012, implemented the standard operating procedure on February 1^st 2012 and collected post intervention data from February 1^st 2012 until October 31^st 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.

Results

The 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).

Conclusion

We have shown that the implementation of a standard operating procedure for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists’ behaviour.

【 授权许可】

   
2013 Rognås et al.; licensee BioMed Central Ltd.

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