Patrick Druwé1, Koenraad G Monsieurs2, James Gagg3, Shinji Nakahara4, Michael N Cocchi5, Gábor Élő6, Hans van Schuppen7, Evan Avraham Alpert8, Anatolij Truhlář9, Sofie A Huybrechts10, Nicolas Mpotos11, Peter Paal12, Conrad BjØrshol13, Theodoros Xanthos14, Luc-Marie Joly15, Markus Roessler16, Conor Deasy17, Hildigunnur Svavarsdóttir18, Jouni Nurmi19, Radoslaw Owczuk20, Pascual Piñera Salmeron21, Diana Cimpoesu22, Pablo Aguilera Fuenzalida23, Violetta Raffay24, Johan Steen25, Johan Decruyenaere25, Peter De Paepe26, Ruth Piers27, Dominique D Benoit25. 1. Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Electronic address: patrick.druwe@ugent.be. 2. Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium. 3. Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom. 4. Teikyo University School of Medicine, Tokyo, Japan. 5. Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, USA. 6. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary. 7. Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Amsterdam, The Netherlands. 8. Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel. 9. Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic. 10. GZA Hospitals, Antwerp, Belgium. 11. Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. 12. Department of Anesthesiology and Critical Care Medicine, Hospitallers Brothers Hospital, Medical University Salzburg, Austria. 13. Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway. 14. European University, Nicosia, Cyprus; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. 15. Department of Emergency Medicine, Rouen University Hospital, Rouen, France. 16. Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany. 17. Department of Emergency Medicine, Cork University Hospital, Cork, Ireland. 18. Akureyri Hospital and University of Akureyri, Akureyri, Iceland. 19. Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 20. Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland. 21. Hospital General Universitario Reina Sofia, Murcia, Spain. 22. University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania. 23. Pontificia Universidad Católica de Chile, Santiago, Chile. 24. Serbian Resuscitation Council, Novi Sad, Serbia. 25. Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. 26. Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium. 27. Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.
Abstract
INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
INTRODUCTION: Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS: A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS: Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION: Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
Keywords:
Emergency department; Emergency medical services; Futility; Inappropriate cardiopulmonary resuscitation; Moral distress; Out of hospital cardiac arrest