title: An Assessment of Emergency Department Post-Cardiac Arrest Care Variation in Michigan.
abstract: Implementation of postarrest care by individual physicians and systems has been slow. Deadoption, or discontinuation of therapeutic hypothermia (TH) treatment targets, after recent prospective study results has not been well reported. This study assesses practices in the early stages of postarrest care across emergency departments (EDs) in Michigan. A 27-question Internet-based survey was distributed to EDs in Michigan in September 2013. To assess changes in practice after publication of Nielsen et al., we sent follow-up questions to all original respondents a year later. Observational data and descriptive statistics are reported. From the 142 EDs identified, we excluded critical access hospitals (N = 35), free standing EDs (N = 7), EDs that transfer critical patients to tertiary centers (N = 21), and exclusive children's hospitals (N = 3). Of the remaining 76 hospitals, we received 64 (84.2%) responses. We identified 15 respondents with a protocol to specifically initiate ED TH and transfer patients to a higher level of care. The 49 remaining were mostly teaching institutions (N = 34, 69%) and gave the ED physician the ability to initiate TH (N = 40, 82%). On follow-up 12 months later, we received 33/40 (83%) responses, of which only 5 indicated formal or informal change in TH practice or target temperature. There is substantial variation in the practice of ED postarrest care and initiation of TH across the state of Michigan, but few ED TH protocols were changed in a year's time. The consequences of postarrest treatment variability at the state and ED levels are likely under-recognized as an influence on outcome variation between regions.
authors.affiliation: 1 Department of Emergency Medicine, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Pavitra
authors.initials: P
authors.lastname: Kotini-Shah
authors.affiliation: 2 Department of Emergency Medicine, University of Texas Medical School at Houston , Houston, Texas.
authors.forename: Teresa R
authors.initials: TR
authors.lastname: Camp-Rogers
authors.affiliation: 3 Department of Emergency Medicine, William Beaumont Hospital , Royal Oak, Michigan.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
authors.affiliation: 3 Department of Emergency Medicine, William Beaumont Hospital , Royal Oak, Michigan.
authors.forename: Kelly N
authors.initials: KN
authors.lastname: Sawyer
mesh_terms: D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D008824:Michigan; D011795:Surveys and Questionnaires