End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey
Introduction: Procedural sedation and analgesia (PSA) provides safe and effective relief for pain, anxiety and discomfort during procedures performed in the emergency department (ED). Our objective was to identify hospital-level factors associated with routine PSA capnography use in the ED. Methods:...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
eScholarship Publishing, University of California
2019-02-01
|
Series: | Western Journal of Emergency Medicine |
Online Access: | https://escholarship.org/uc/item/55s1g9j5 |
id |
doaj-35dff9fd4b7642889216fa6dee2ef5ad |
---|---|
record_format |
Article |
spelling |
doaj-35dff9fd4b7642889216fa6dee2ef5ad2020-11-25T02:58:24ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-90182019-02-0120210.5811/westjem.2018.12.40554wjem-20-232End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System SurveySteven A. Ilko0J. Priyanka Vakkalanka1Azeemuddin Ahmed2Daniel A. Evans3Hans R. House4Nicholas M. Mohr5University of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IowaUniversity of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IowaUniversity of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IowaIndiana University, Department of Emergency Medicine, Indianapolis, IndianaUniversity of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IowaUniversity of Iowa Carver College of Medicine, Department of Emergency Medicine, Iowa City, IowaIntroduction: Procedural sedation and analgesia (PSA) provides safe and effective relief for pain, anxiety and discomfort during procedures performed in the emergency department (ED). Our objective was to identify hospital-level factors associated with routine PSA capnography use in the ED. Methods: This study was a cross-sectional telephone survey of ED nurse managers and designees in a Midwestern state. Respondents identified information about hospital infrastructure, physician staffing, family practice (FP) physicians only, board-certified emergency physicians (EPs) only (or both), and critical intervention capabilities. Additional characteristics including ED volume and hospital designation (i.e., rural-urban classification) were obtained from the Centers for Medicare and Medicaid Services and the state hospital association database, respectively. The primary outcome was reported use of PSA capnography. We conducted univariate analyses (relative risks, 95% confidence interval [CI]) to identify associations between hospital-level characteristics and PSA capnography use. Results: We had an overall response rate of 98% (n=118 participating hospitals). The majority of EDs were in rural settings (78%), with a median of 5,057 visits per year (interquartile range 2,823–14,322). Nearly half of the EDs were staffed by FP physicians only, while 16% had board-certified EPs only. Nearly all hospitals (n=114, 97%), reported using continuous capnography for ventilated patients, and 74% reported use of capnography during PSA. Urban hospitals were more likely to use PSA capnography than critical access hospitals (relative risk 1.45; 95% CI, 1.22–1.73), and PSA capnography use increased with each ED volume quartile. Facilities with only EPs were 1.46 (95% CI, 1.15–1.87) times more likely to use PSA capnography than facilities with FP physicians only. Conclusion: Continuous capnography was available in nearly all EDs, independent of size, location or patient volume. The implementation of capnography during PSA was less penetrant. Smaller, rural departments were less likely than their larger, urban counterparts to implement these national guidelines. Rurality and hospital size may be potential institutional barriers to capnography implementation.https://escholarship.org/uc/item/55s1g9j5 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Steven A. Ilko J. Priyanka Vakkalanka Azeemuddin Ahmed Daniel A. Evans Hans R. House Nicholas M. Mohr |
spellingShingle |
Steven A. Ilko J. Priyanka Vakkalanka Azeemuddin Ahmed Daniel A. Evans Hans R. House Nicholas M. Mohr End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey Western Journal of Emergency Medicine |
author_facet |
Steven A. Ilko J. Priyanka Vakkalanka Azeemuddin Ahmed Daniel A. Evans Hans R. House Nicholas M. Mohr |
author_sort |
Steven A. Ilko |
title |
End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey |
title_short |
End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey |
title_full |
End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey |
title_fullStr |
End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey |
title_full_unstemmed |
End-tidal CO 2 Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey |
title_sort |
end-tidal co 2 monitoring is available in most community hospitals in a rural state: a health system survey |
publisher |
eScholarship Publishing, University of California |
series |
Western Journal of Emergency Medicine |
issn |
1936-9018 |
publishDate |
2019-02-01 |
description |
Introduction: Procedural sedation and analgesia (PSA) provides safe and effective relief for pain, anxiety and discomfort during procedures performed in the emergency department (ED). Our objective was to identify hospital-level factors associated with routine PSA capnography use in the ED. Methods: This study was a cross-sectional telephone survey of ED nurse managers and designees in a Midwestern state. Respondents identified information about hospital infrastructure, physician staffing, family practice (FP) physicians only, board-certified emergency physicians (EPs) only (or both), and critical intervention capabilities. Additional characteristics including ED volume and hospital designation (i.e., rural-urban classification) were obtained from the Centers for Medicare and Medicaid Services and the state hospital association database, respectively. The primary outcome was reported use of PSA capnography. We conducted univariate analyses (relative risks, 95% confidence interval [CI]) to identify associations between hospital-level characteristics and PSA capnography use. Results: We had an overall response rate of 98% (n=118 participating hospitals). The majority of EDs were in rural settings (78%), with a median of 5,057 visits per year (interquartile range 2,823–14,322). Nearly half of the EDs were staffed by FP physicians only, while 16% had board-certified EPs only. Nearly all hospitals (n=114, 97%), reported using continuous capnography for ventilated patients, and 74% reported use of capnography during PSA. Urban hospitals were more likely to use PSA capnography than critical access hospitals (relative risk 1.45; 95% CI, 1.22–1.73), and PSA capnography use increased with each ED volume quartile. Facilities with only EPs were 1.46 (95% CI, 1.15–1.87) times more likely to use PSA capnography than facilities with FP physicians only. Conclusion: Continuous capnography was available in nearly all EDs, independent of size, location or patient volume. The implementation of capnography during PSA was less penetrant. Smaller, rural departments were less likely than their larger, urban counterparts to implement these national guidelines. Rurality and hospital size may be potential institutional barriers to capnography implementation. |
url |
https://escholarship.org/uc/item/55s1g9j5 |
work_keys_str_mv |
AT stevenailko endtidalco2monitoringisavailableinmostcommunityhospitalsinaruralstateahealthsystemsurvey AT jpriyankavakkalanka endtidalco2monitoringisavailableinmostcommunityhospitalsinaruralstateahealthsystemsurvey AT azeemuddinahmed endtidalco2monitoringisavailableinmostcommunityhospitalsinaruralstateahealthsystemsurvey AT danielaevans endtidalco2monitoringisavailableinmostcommunityhospitalsinaruralstateahealthsystemsurvey AT hansrhouse endtidalco2monitoringisavailableinmostcommunityhospitalsinaruralstateahealthsystemsurvey AT nicholasmmohr endtidalco2monitoringisavailableinmostcommunityhospitalsinaruralstateahealthsystemsurvey |
_version_ |
1724706554575323136 |