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      Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services

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          Abstract

          Background

          Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process.

          Methods

          The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records.

          Results

          During the study period (2012–2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25–42] vs. 29 [IQR 21–39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7–77.8%) to 97.6% (95% CI 96.7–98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0–73.9%) to 93.4% (95% CI 92.3–94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6–88.9%) to 98.5% (95% CI 97.7–99.0%), respectively. Deterioration in compliance indicators was not observed.

          Conclusions

          We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.

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          Most cited references40

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.

          Erik von Elm, Douglas G. Altman, Matthias Egger … (2014)
          Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            Making sense of implementation theories, models and frameworks

            Per Torgeir E Nilsen (2015)
            Background Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers. Discussion Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). Summary This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited “how-to” support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.
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              The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care.

              Shannon Stirman, Rachel C. Shelton, Brittany Cooper (2018)
              There is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research.
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                Author and article information

                Contributors
                Susanne Ångerman: susanne.angerman-haasmaa@hus.fi
                Hetti Kirves: hetti.kirves@hus.fi
                Jouni Nurmi:
                ORCID: http://orcid.org/0000-0002-1920-4869
                jouni.nurmi@hus.fi
                Journal
                Journal ID (nlm-ta): Scand J Trauma Resusc Emerg Med
                Journal ID (iso-abbrev): Scand J Trauma Resusc Emerg Med
                Title: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1757-7241
                Publication date (Electronic): 30 April 2023
                Publication date PMC-release: 30 April 2023
                Publication date Collection: 2023
                Volume: 31
                Electronic Location Identifier: 21
                Affiliations
                GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Department of Emergency Medicine and Services, , Helsinki University Hospital and University of Helsinki, ; FinnHEMS 10, Vesikuja 9, 01530 Vantaa, Finland
                Author information
                http://orcid.org/0000-0002-1920-4869
                Article
                Publisher ID: 1086
                DOI: 10.1186/s13049-023-01086-w
                PMC ID: 10148755
                PubMed ID: 37122004
                SO-VID: e273d0a4-7a73-4250-baa2-79a36a076087
                Copyright © © The Author(s) 2023
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 13 November 2022
                Date accepted : 18 April 2023
                Funding
                Funded by: Helsinki University Hospital
                Award ID: state funding (VTR TYH2017220)
                Funded by: University of Helsinki including Helsinki University Central Hospital
                Open Access :

                Open Access funding provided by University of Helsinki including Helsinki University Central Hospital.

                Categories
                Subject: Original Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2023

                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: prehospital emergency anaesthesia,intubation,implementation,prehospital,on-scene time,hems
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma
                Keywords: prehospital emergency anaesthesia, intubation, implementation, prehospital, on-scene time, hems

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