title: Experiences with capnography in acute care settings: a mixed-methods analysis of clinical staff.
abstract: OBJECTIVE
  Although capnography is being incorporated into clinical guidelines, it is not used to its full potential. We investigated reasons for limited implementation of capnography in acute care areas and explored facilitators and barriers to its implementation.
  
  
  METHODS
  A purposeful sample of physicians and nurses in emergency departments and intensive care units participated in semistructured interviews. Grounded theory, iterative data analysis, and the constant comparative method were used to analyze the data to inductively generate ideas and build theories.
  
  
  RESULTS
  Nineteen providers were interviewed from 5 hospitals. Six themes were identified: variability in use of capnography among acute care units, availability and accessibility of capnography equipment, the evidence behind capnography use, the impact of capnography on patient care, personal experiences impacting use of capnography, and variable knowledge about capnography. Barriers and facilitators to use were found within each theme.
  
  
  CONCLUSIONS
  We observed varied responsiveness to capnography and identified factors that work to foster or discourage its use. These data can guide future implementation strategies. A deliberate strategy to foster utilization, mitigate barriers, and broadly accelerate implementation has the potential to profoundly impact use of capnography in acute care areas with the goal of improving patient care.
authors.affiliation: Section of Emergency Medicine, Yale University School of Medicine. Electronic address: Melissa.Langhan@yale.edu.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Langhan
authors.affiliation: St. George's University School of Medicine.
authors.forename: Jordan C
authors.initials: JC
authors.lastname: Kurtz
authors.affiliation: Department of Pediatrics, Yale University School of Medicine.
authors.forename: Paula
authors.initials: P
authors.lastname: Schaeffer
authors.affiliation: Department of Pediatrics, Yale University School of Medicine.
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Asnes
authors.affiliation: Section of Emergency Medicine, Yale University School of Medicine.
authors.forename: Antonio
authors.initials: A
authors.lastname: Riera
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019296:Capnography / Q000295:instrumentation / Q000523:psychology / Q000706:statistics & numerical data*; D003422:Critical Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D066296:Grounded Theory; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D036301:Qualitative Research
keywords: Capnography; Emergency department; Implementation; Intensive care unit