title: Implementation of the guidelines for targeted temperature management after cardiac arrest: a longitudinal qualitative study of barriers and facilitators perceived by hospital resuscitation champions.
abstract: OBJECTIVE
  To identify the barriers to and facilitators of implementing guidelines for targeted temperature management (TTM) after cardiac arrest perceived by hospital resuscitation champions and to investigate the changes in their perceptions over the early implementation period.
  
  
  METHODS
  A longitudinal qualitative study (up to 2 serial semistructured interviews over 1 year and focus groups). The individual interviews and focus groups were transcribed and coded by 2 independent assessors. Contents were analysed thematically; group interaction was also examined.
  
  
  METHODS
  21 hospitals, including community and tertiary care centres in South Korea.
  
  
  METHODS
  21 hospital champions (14 acting champions and 7 managerial champions).
  
  
  RESULTS
  The final data set included 40 interviews and 2 focus groups. The identified barriers and facilitators could be classified into 3 major themes: (1) healthcare professionals' perceptions of the guidelines and protocols, (2) interdisciplinary and interprofessional collaboration and (3) organisational resources. Lack of resources was the most commonly agreed on barrier for the acting champions, whereas lack of interdisciplinary collaboration was the most common barrier for the managerial champions. Educational activities and sharing successfully treated cases were the most frequently identified facilitators. Most of the participants identified and agreed that cooling equipment was an important barrier as well as a facilitator of successful TTM implementation. Perception of the guidelines and protocols has improved with the accumulation of clinical experience over the study period.
  
  
  CONCLUSIONS
  Healthcare professionals' internal barriers to TTM implementation may be influenced by new guidelines and can be changed with the accumulation of successful clinical experiences during the early implementation period. Promoting interprofessional and interdisciplinary collaboration through educational activities and the use of cooling equipment with an automated feedback function can improve adherence to guidelines in hospitals with limited human resources in critical care.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Myongji Hospital, Goyang-si, Gyeonggi-do, Korea.
authors.forename: Seung Joon
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Sun Jin
authors.initials: SJ
authors.lastname: Jo
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001833:Body Temperature Regulation; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017144:Focus Groups; D019983:Guideline Adherence; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D033183:Interdisciplinary Communication; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D056910:Republic of Korea
keywords: ACCIDENT & EMERGENCY MEDICINE; QUALITATIVE RESEARCH