title: Adherence to guideline-based standard operating procedures in pre-hospital emergency patients with chronic obstructive pulmonary disease.
abstract: This study investigated improvements in pre-hospital care for patients with acute exacerbated chronic obstructive pulmonary disease (aeCOPD) achieved by using a standard operating procedure (SOP). An SOP for pre-hospital treatment of patients with aeCOPD was designed based on valid national guidelines. A total of 1000 Emergency Medical Service patient care reports were analysed prospectively: 500 before and 500 after introduction of the SOP. Overall guideline adherence was 34.6% before and 53.8% after introduction of the SOP; this increase was not statistically significant. After SOP introduction, the administration of β(2) mimetics by inhalative, intravenous and subcutaneous routes increased significantly. The level of knowledge of the national guidelines was rated at 67% by emergency physicians during self-assessment, but was only 33% when physicians were asked specific questions during interview. Introducing the SOP for patients with aeCOPD did not significantly improve adherence to valid national guidelines, but did help to improve specific elements of therapy.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Bosse
authors.forename: W
authors.initials: W
authors.lastname: Schmidbauer
authors.forename: C D
authors.initials: CD
authors.lastname: Spies
authors.forename: M
authors.initials: M
authors.lastname: Sörensen
authors.forename: R C E
authors.initials: RC
authors.lastname: Francis
authors.forename: F
authors.initials: F
authors.lastname: Bubser
authors.forename: M
authors.initials: M
authors.lastname: Krebs
authors.forename: T
authors.initials: T
authors.lastname: Kerner
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000592:standards*; D005858:Germany; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007297:Inpatients; D010100:Oxygen / Q000008:administration & dosage; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000628:therapy*; D012647:Self-Assessment; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D001993:Bronchodilator Agents; D010100:Oxygen