Standard operating procedure changed pre-hospital critical care anaesthesiologists' behaviour: a
quality control study
Sammanfattning
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 1st 2011 to January 31st 2012,
implemented the standard operating procedure on February 1st 2012 and collected post intervention
data from February 1st 2012 until October 31st 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.