Targeted Temperature Management: Effects of Initial Protocol Implementation on Patient Outcomes.
BACKGROUND
Targeted temperature management (TTM) is a strategy used by critical care nurses to mitigate negative effects of out-of-hospital cardiac arrest (OHCA); however, integration and compliance of TTM protocols into routine clinical practice can be challenging.


OBJECTIVE
The aims of this study are to (1) investigate the effects of initial TTM protocol implementation on patient mortality, length of stay, and discharge disposition among patients who experience OHCA and (2) evaluate initial compliance and potential barriers to newly implemented TTM protocol.


METHODS
A retrospective cohort design was used. Data were gathered on adult patients experiencing OHCA before and after immediate implementation of a TTM protocol within a large academic public hospital. Demographic and clinical data were abstracted from medical records of both TTM and non-TTM groups. Additional compliance data were gathered on the TTM group. Outcome variables included hospital mortality, length of stay, and discharge disposition.


RESULTS
Total accrual was 259. Mortality decreased after protocol implementation (89.4%, 75%, P < .05), which was supported in the regression analyses (P = .05; odds ratio, 2.8). A higher proportion of subjects were discharged home after the TTM protocol (21.5% discharged home after protocol implementation vs 5.1% discharged home before protocol implementation; P < .05). Full protocol compliance was 30%. Protocol documentation was inconsistent across units and personnel.


CONCLUSIONS
Findings suggest that even initial implementation of TTM protocols can result in positive patient outcomes. Full compliance with protocols remains difficult. Critical care nurses are integral to initiation of and adherence to therapeutic hypothermia protocols and are in a key position to develop strategies for improved compliance across departments.
Jessica Wyse, MSN, RN, is a clinical nurse at The MetroHealth System and a member of the hospital rapid response team. She is also a doctoral student at Kent State University. Molly McNett, PhD, RN, CNRN, is director of nursing research at The MetroHealth System. In this role, she directs and oversees all nurse-led research throughout the health system.
Jessica
J
Wyse
Molly
M
McNett
D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge; D012189:Retrospective Studies