Fully automatic external defibrillators in acute care: Clinicians' experiences and perceptions.
BACKGROUND
Fully automatic external defibrillators (FAEDs) reduce the time to defibrillation [Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, et al. Advances in treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41(4):627-32; Mattioni T, Kanaan N, Riggio D, Bahu M, Lin D, Welch S, et al. Performance of an automatic external-cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia. Am J Cardiol 2003;91:1323-6] and improve outcomes [Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, et al. Advances in treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41(4):627-32]. There is, however, no guidance or standard about their use in the UK. This paper presents the results of a study, which explored clinicians' experiences and perceptions of using FAEDs in acute care in the UK.


OBJECTIVE
This study sought to understand clinicians' experiences and perceptions of the use of FAEDs in acute care and their impact on decision making.


METHODS
Using a qualitative approach, 43 nurses and four physicians were included in a trial of FAEDs in a Coronary Care Unit (CCU) and cardiology ward during 2004. Semi-structured interviews were conducted with nurses and physicians prior to and following the trial. Data were analysed using thematic analysis [Attride-Stirling J, Thematic networks: an analytic to research. Qual Res 2001;1(3):385-405].


RESULTS
Decision control, safety, a lack of confidence in the technology, previous experience and concerns about the psychological affect on patients affected clinicians' decision making and limited the use of the FAED.


CONCLUSIONS
Despite reported benefits of the FAED [Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, et al. Advances in treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41(4):627-32; Mattioni T, Kanaan N, Riggio D, Bahu M, Lin D, Welch S, et al. Performance of an automatic external-cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia. Am J Cardiol 2003;91:1323-26], personal and contextual issues affected the clinicians' decision making. More and better understanding about how FAEDs and their context of use may challenge established practice is required in order that it is utilised in the most effective way.
Northumbria University, School of Health Community and Education Studies, Newcastle-upon-Tyne NE7 7XA, UK. Helen.hancock@durham.ac.uk
Helen C
HC
Hancock
Alun
A
Roebuck
Martyn
M
Farrer
Steve
S
Campbell
D001291:Attitude of Health Personnel; D001331:Automation / Q000295:instrumentation*; D002983:Clinical Competence; D003325:Coronary Care Units; D003422:Critical Care; D003657:Decision Making; D047548:Defibrillators / Q000009:adverse effects / Q000523:psychology / Q000592:standards*; D004554:Electric Countershock / Q000295:instrumentation / Q000451:nursing; D004638:Emergency Treatment; D004867:Equipment Design; D004868:Equipment Failure; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology*; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012647:Self-Assessment; D011795:Surveys and Questionnaires; D013673:Technology Assessment, Biomedical; D006113:United Kingdom