Center for Resuscitation Science and Department of Emergency Medicine, Section of Pulmonary Allergy and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
J Crit Care. 2013 Jun;28(3):259-64. doi: 10.1016/j.jcrc.2012.10.010. Epub 2012 Dec 21.
Post-arrest targeted temperature management (TTM) has been shown to dramatically improve outcomes after resuscitation, yet studies have revealed inconsistent and slow adoption. Little is known about barriers to TTM implementation and methods to increase adoption. We hypothesized that a structured educational intervention might increase TTM use.
Subjects participated in mixed quantitative/qualitative surveys before and after attending a series of TTM educational courses from October 2010 to October 2011, to determine usage and barriers to implementation. A knowledge examination was also administered to participants before and after the course.
Clinicians completed 227 surveys (129 pre-training and 98 post-training) and 343 exams (165 pre-training and 178 post-training). A ranking survey (score range 1-7; 7 as most challenging) found that communication challenges (mean score 4.7 ± 1.5) and lacking adequate education (4.3 ± 1.9) were the 2 most emphasized barriers to implementation. Post-survey results found that 95% (93/98) of respondents felt more confident initiating TTM post-intervention. There was a statistically significant increase in self-reported TTM usage after participation in the program (P < .01).
A focused TTM program led to increased confidence and usage among participants. Future work will focus on targeted training to address specific barriers and increase TTM utilization.
在复苏后,靶目标温度管理(TTM)已被证明能显著改善预后,但研究表明其采用率不一致且缓慢。对于 TTM 实施的障碍以及提高采用率的方法知之甚少。我们假设,结构化的教育干预可能会增加 TTM 的使用。
2010 年 10 月至 2011 年 10 月,研究对象参加了一系列 TTM 教育课程,在参加课程前后通过混合定量/定性调查来确定使用情况和实施障碍。还在课程前后对参与者进行了知识考试。
临床医生完成了 227 份调查(129 份培训前和 98 份培训后)和 343 份考试(165 份培训前和 178 份培训后)。一项排名调查(评分范围 1-7;7 为最具挑战性)发现,沟通挑战(平均得分 4.7 ± 1.5)和缺乏足够的教育(4.3 ± 1.9)是实施的 2 个最突出的障碍。调查结果发现,95%(93/98)的受访者在干预后更有信心开始 TTM。参与该计划后,自我报告的 TTM 使用量显著增加(P <.01)。
有针对性的 TTM 计划提高了参与者的信心和使用量。未来的工作将集中在有针对性的培训上,以解决特定的障碍并提高 TTM 的利用率。