Faculty Collaboration Database

Knowledge translation in emergency medical services: a qualitative survey of barriers to guideline implementation. Resuscitation 2010 Jul;81(7):836-40

Date

04/20/2010

Pubmed ID

20398994

Pubmed Central ID

PMC3209799

DOI

10.1016/j.resuscitation.2010.03.012

Scopus ID

2-s2.0-77953722725 (requires institutional sign-in at Scopus site)   46 Citations

Abstract

BACKGROUND: The American Heart Association (AHA) released guidelines to improve survival rates from out-of-hospital cardiac arrest in 2005. We sought to identify what barriers delayed the implementation of these guidelines in EMS agencies.

METHODS: We surveyed 178 EMS agencies as part of a larger quantitative survey regarding guideline implementation and conducted a single-question semi-structured interview using the Grounded Theory method. We asked "What barriers if any, delayed implementation of the (2005 AHA) guidelines in your EMS agency?" Data were coded and member validation was employed to verify our findings.

RESULTS: 176/178 agencies completed the quantitative survey. Qualitative data collection ceased after reaching theoretical saturation with 34 interviews. Ten unique barriers were identified. We categorized these 10 barriers into three themes. The theme instruction delays (reported by 41% of respondents) included three barriers: booking/training instructors (9%), receiving training materials (15%), and scheduling staff for training (18%). The second theme, defibrillator delays (38%), included two barriers; reprogramming defibrillators (24%) and receiving new defibrillators to replace non-upgradeable units (15%). The third theme was decision-making (38%) and included five barriers; coordinating with allied agencies (9%), government regulators such as state and provincial health authorities (9%), medical direction and base hospitals (9%), ROC participation (9%), and internal crises (3%).

CONCLUSION: Many barriers contributed to delays in the implementation of the 2005 AHA guidelines in EMS agencies. These identified barriers should be proactively addressed prior to the 2010 Guidelines to facilitate rapid translation of science into clinical practice.

Author List

Bigham BL, Aufderheide TP, Davis DP, Powell J, Donn S, Suffoletto B, Nafziger S, Stouffer J, Morrison LJ, ROC Investigators

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

American Heart Association
Canada
Cardiopulmonary Resuscitation
Clinical Competence
Emergency Medical Services
Female
Guideline Adherence
Health Care Surveys
Heart Arrest
Humans
Male
Practice Guidelines as Topic
Quality of Health Care
Risk Assessment
Survival Analysis
United States