PMID- 19386880
OWN - NLM
STAT- MEDLINE
DCOM- 20090611
LR  - 20090423
IS  - 1472-0213 (Electronic)
IS  - 1472-0205 (Linking)
VI  - 26
IP  - 5
DP  - 2009 May
TI  - Evaluation of attitudes and perceptions of key clinical stakeholders regarding 
      out-of-hospital diagnosis and treatment of ST elevation myocardial infarction 
      patients using a region-wide survey.
PG  - 371-6
LID - 10.1136/emj.2008.066126 [doi]
AB  - INTRODUCTION: In ST elevation myocardial infarction (STEMI), prehospital 
      management (PHM) may improve clinical outcomes through a reduction in reperfusion 
      delay. The purpose of this study was to evaluate perceptions among healthcare 
      stakeholder groups relating to the barriers and facilitators of implementing a 
      PHM programme. METHODS: A 25-question cross-sectional survey, using a four-point 
      Likert scale assessing barriers and facilitators of PHM, was distributed to 
      paramedics, cardiologists, emergency physicians and emergency nurses within the 
      Edmonton region, where prehospital STEMI treatment is established. The proportion 
      of responses on each question was compared and differences between groups were 
      determined using chi(2) and Fisher's exact tests. RESULTS: 57% (355/619) of 
      subjects responded: 69% paramedics, 50% cardiologists, 54% emergency physicians 
      and 45% emergency nurses. A majority believed PHM reduced treatment delays in 
      both rural (96-100%) and urban (86-96%) areas, while decreasing patient mortality 
      (paramedics 97%, cardiologists 74%, emergency physicians 85%, emergency nurses 
      88%). Regarding the capability of paramedics to deliver PHM, paramedics 25%, 
      cardiologists 33%, emergency physicians 67%, and emergency nurses 47% stated that 
      urban paramedics are better equipped and trained than rural paramedics. Although 
      81% of paramedics supported the possibility of PHM delivery without physician 
      overview, 0% of cardiologists, 98% of emergency physicians and 95% emergency 
      nurses agreed. A majority (71-88%) favoured mandatory signed informed consent. 
      CONCLUSIONS: While stakeholders agreed on the benefits of PHM, perceptual 
      differences existed on paramedics' ability to deliver PHM without physician 
      overview. Addressing real and perceived barriers through communication and 
      educational programmes may enhance PHM within this healthcare region and 
      facilitate the implementation of PHM programmes.
FAU - Rajabali, N A
AU  - Rajabali NA
AD  - Epidemiology Coordinating and Research (EPICORE) Centre, University of Alberta, 
      Edmonton, Alberta, Canada.
FAU - Tsuyuki, R T
AU  - Tsuyuki RT
FAU - Sookram, S
AU  - Sookram S
FAU - Simpson, S H
AU  - Simpson SH
FAU - Welsh, R C
AU  - Welsh RC
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - England
TA  - Emerg Med J
JT  - Emergency medicine journal : EMJ
JID - 100963089
SB  - IM
MH  - Alberta
MH  - Allied Health Personnel
MH  - *Attitude of Health Personnel
MH  - Cross-Sectional Studies
MH  - Delivery of Health Care/organization & administration
MH  - Emergency Medical Services/*organization & administration
MH  - Emergency Nursing
MH  - Humans
MH  - Informed Consent
MH  - Myocardial Infarction/*diagnosis/therapy
MH  - Rural Health Services/organization & administration
MH  - Urban Health Services/organization & administration
EDAT- 2009/04/24 09:00
MHDA- 2009/06/12 09:00
CRDT- 2009/04/24 09:00
PHST- 2009/04/24 09:00 [entrez]
PHST- 2009/04/24 09:00 [pubmed]
PHST- 2009/06/12 09:00 [medline]
AID - 26/5/371 [pii]
AID - 10.1136/emj.2008.066126 [doi]
PST - ppublish
SO  - Emerg Med J. 2009 May;26(5):371-6. doi: 10.1136/emj.2008.066126.