title: Standard operating procedure changed pre-hospital critical care anaesthesiologists' behaviour: a quality control study.
abstract: BACKGROUND
  The ability of standard operating procedures to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect on pre-hospital critical care anaesthesiologists' behaviour of implementing a standard operating procedure for pre-hospital controlled ventilation.
  
  
  METHODS
  Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data according to the Utstein-style template. We collected pre-intervention data from February 1st 2011 to January 31st 2012, implemented the standard operating procedure on February 1st 2012 and collected post intervention data from February 1st 2012 until October 31st 2012. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. The objective was to evaluate whether the development and implementation of a standard operating procedure for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists' behaviour and thereby increase the use of automated ventilators in these patients.
  
  
  RESULTS
  The implementation of a standard operating procedure increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 (0.34-0.47) to 0.74 (0.69-0.80) with a prevalence ratio of 1.85 (1.57-2.19) (p = 0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 (0.26-0.62) to 0.85 (0.62-0.97) with a prevalence ratio of 1.94 (1.26-3.0) (p = 0.0039). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 (0.26-0.48) to 0.69 (0.58-0.78) with a prevalence ratio of 1.79 (1.36-2.35) (p = 0.00).
  
  
  CONCLUSIONS
  We have shown that the implementation of a standard operating procedure for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists' behaviour.
authors.affiliation: Department of research and development, Norwegian Air Ambulance Foundation, P,O, Pox 94, Drøbak, 1441 Norway. leifrogn@rm.dk.
authors.forename: Leif
authors.initials: L
authors.lastname: Rognås
authors.forename: Troels Martin
authors.initials: TM
authors.lastname: Hansen
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
authors.forename: Else
authors.initials: E
authors.lastname: Tønnesen
mesh_terms: D017732:Air Ambulances; D000776:Anesthesiology / Q000379:methods / Q000592:standards*; D001930:Brain Injuries; D002985:Clinical Protocols; D003422:Critical Care / Q000592:standards*; D003718:Denmark; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011786:Quality Control; D019984:Quality Indicators, Health Care; D012121:Respiration, Artificial / Q000379:methods; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data