Assessing contextual factors influence on patient outcomes after advanced life support provision in acute care units by multidisciplinary team at University Teaching Hospital of Butare

Abstract

Introduction Advanced life support (ALS) is an advanced intervention that follows a basic life support (BLS).Intervention for critically ill patient. ALS it can be performed in hospital and /in or pre-hospital care after patient experiencing cardiopulmonary arrest. ALS performed with experienced health care providers.

Background Cardiac arrest in hospital (IHCA) and in out-of-hospital (OHCA) remains global health issues. The incidence of OHCA worldwide is between 20 to 140 per 100.000 of the population and survival after BLS and ALS range between 2 and 11% .That implies that between 18 to 120% do not benefit from ALS. The outcome of ALS is influenced by contextual such as multidisciplinary team, knowledge, skills, training in ALS and availability of the functioning equipment and medications. In addition, team work, communication, coordination and leadership are the keys factors in ALS provision Objective: To assess contextual factors influence on patients outcomes after ALS provision in acute care units by multidisciplinary team at University Teaching Hospital of Butare

Methodology : To achieve the objectives of the project, a quantitative research with a cross –sectional study design was conducted based on convenience sampling of 105 participants among the nurses , medical doctors , anesthetist technician/anesthesiologist and EMCC in UTHB , using questionnaire adapted from previous study. The questionnaire was developed from research conducted at tertiary care hospital in Sri Lanka (1) and the questions from the AHA guideline after getting permission to use it. Descriptive statistics, bi-variate and correlation test (correlation matrix) were calculated using SPSS 20 to describe relationship of factors influence and patients outcome in ALS.

Results: Participants were 98 staff for 105 sample size .were 7 staff were not participants during data collection, 63.30% males and 34.70% females ,majority of participants were 36-45years range (46.93%) , among them majorities are nurses A1 43(43.87%) ,majority had working experience of 10 years and above 42(42.83%) and are located in emergency department(30.60%) .In general , of them 56.58% demonstrated inadequate ALS knowledge and 53,58% do not have level of training in ALS. The level of knowledge based socio-demographic data , gender and age are not statistically significant to have knowledge about ALS at p-value >0.05 , while working 7 experience and working rooms are statistically significant to have knowledge on ALS at p value <0.05. In addition, academic qualifications, working experience and working room are statistically significant to have level of training on ALS at p-value <0.05. Availability of equipment, materials and drugs , average is 72.44% and multidisciplinary team work in handling critically ill patients is 75.10%. However, there are association of factors influence and getting good outcome in ALS as correlation test is (0, 1)

Conclusion: A significantly high proportional are nurses as are the high numbers of participants 76/98 and 55(56.12%) do not have adequate knowledge compare to the anesthetist technician A1/A0 , medical doctors , anesthesiologist and Emergency Medicine and Critical Care (EMCC) . In addition, high number of study participants demonstrated low training capacity in ALS , where about 53.58% are not trained in ALS. Low prevalence of rate survival to discharge and high prevalence of death is in 1-2days after cardiac arrest care are observed and are probably due to inadequate of knowledge of study participants and low training capacity in ALS as shown in table3 and 4.