TY - JOUR
T1 - Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job
T2 - Results from a cross-sectional survey in 288 centres across 24 countries
AU - REAPPROPRIATE study group
AU - Druwé, Patrick
AU - Monsieurs, Koenraad G
AU - Gagg, James
AU - Nakahara, Shinji
AU - Cocchi, Michael N
AU - Élő, Gábor
AU - van Schuppen, Hans
AU - Alpert, Evan Avraham
AU - Truhlář, Anatolij
AU - Huybrechts, Sofie A
AU - Mpotos, Nicolas
AU - Paal, Peter
AU - BjØrshol, Conrad
AU - Xanthos, Theodoros
AU - Joly, Luc-Marie
AU - Roessler, Markus
AU - Deasy, Conor
AU - Svavarsdóttir, Hildigunnur
AU - Nurmi, Jouni
AU - Owczuk, Radoslaw
AU - Salmeron, Pascual Piñera
AU - Cimpoesu, Diana
AU - Fuenzalida, Pablo Aguilera
AU - Raffay, Violetta
AU - Steen, Johan
AU - Decruyenaere, Johan
AU - De Paepe, Peter
AU - Piers, Ruth
AU - Benoit, Dominique D
N1 - Funding Information: CAB is employed by the Regional Competence Centre for Acute Medicine in Western Norway (RAKOS) with financial support from the Norwegian Directorate of Health. He has participated in Global Resuscitation Alliance meetings sponsored by the Laerdal Foundation for Acute Medicine, TrygFonden and EMS2018. CD is Deputy Medical Director of the National Ambulance Service of the Republic of Ireland. The other authors declared no conflicts of interest. Funding Information: RP is supported by Fund Marie-Thérèse De Lava, King Baudouin Foundation , Belgium. DDB received a senior clinical investigators grant (1800513N) from the Research Foundation Flanders (FWO). Publisher Copyright: © 2020 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians.METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals.RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]).CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
AB - INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians.METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals.RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]).CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
KW - Emergency department
KW - Emergency medical services
KW - Futility
KW - Inappropriate cardiopulmonary resuscitation
KW - Moral distress
KW - Out of hospital cardiac arrest
UR - http://www.scopus.com/inward/record.url?scp=85097132745&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.resuscitation.2020.10.043
DO - https://doi.org/10.1016/j.resuscitation.2020.10.043
M3 - Article
C2 - 33227397
SN - 0300-9572
VL - 158
SP - 41
EP - 48
JO - Resuscitation
JF - Resuscitation
ER -