Abstract 167: Barriers to Adoption of Postarrest Therapeutic Hypothermia and Methods to Increase Implementation
Background: Post-arrest therapeutic hypothermia (TH) has been shown to dramatically improve outcomes after resuscitation, yet studies have revealed that TH adoption has been inconsistent and slow. Little is known about barriers to TH implementation and methods to increase adoption.
Objective: We hypothesized that lack of education surrounding implementation is a more important barrier to TH adoption than lacking institutional leadership support or physician acceptance, and that an educational intervention might increase TH use.
Methods: We administered mixed quantitative/qualitative surveys to clinicians before and after enrollment in a series of TH educational courses from 10/2009 to 7/2011, to determine usage and barriers to implementation. Six months post-training, self-reported clinician confidence and use of TH was assessed in the same cohort.
Results: Clinicians completed 160 surveys (81 pre-training and 79 post-training). Of those, 74% were nurses, 24% were physicians; most represented ICU or ED practitioners. A ranking survey (score range 1-7; 7 as most important) found that lack of adequate staffing (mean score 4.5+2.1) and adequate education (4.4 + 1.6) were the two most emphasized barriers to TH implementation. Lacking institutional leadership support or physician acceptance was the least emphasized barrier (2.5+1.6, 3.3+2.0 respectively). Mean scores were significantly different between the expressed lack of adequate education and either institutional support or physician acceptance (p<0.01, p=0.02, respectively). Post-survey results found that 96% of respondents felt more confident initiating TH post-educational intervention. There was a statistically significant increase in self-reported TH usage by surveyed clinicians after participation in our TH educational programs (p<0.01).
Conclusions: Practitioners highlighted lack of education surrounding TH implementation as a key barrier to TH use. A focused TH training course led to increased confidence and TH usage among participants. Future work will focus on targeted training to address specific barriers and increase appropriate TH utilization.
- © 2011 by American Heart Association, Inc.