Background and Objective :Advanced cardiac life support (ACLS) is an important knowledge among physicians to deal with cardiac arrest. Medical staff and residents who practice in high risk areas are required to possess ACLS knowledge and skills. To determine knowledge about ACLS in physicians including factors that influence ACLS knowledge in university hospital.
Methods :A descriptive of study of medical staff and residents who have been working at SrinagarindHospital, Khon Kaen University, Thailand, between May-July, 2008 was performed by stratified random sampling from the participated 12 clinical department. The test questions were modified from Advanced Cardiovascular life support guideline (American Heart Association). The total score more than 80% wasclassified as being with sufficient knowledge whereas below 80% was lacking sufficient knowledge.
Results : Seventy physicians were enrolled to take the test. Up to 15.7% (95% CI 8.1-26.4) of those participants have scored over 80%. Mean+SD of percent of the total score, concepts of BLS and ACLS score, ECG interpretation score, medication score, and application score were 58.4+21.5, 55.9+26.5, 73.4 +26.0, 51.0+23.5, and 57.5+30.3, respectively. The statistical analysis suggests that physicians with higher frequency of ACLS practice and training had more knowledge on the issue than those with lower frequency of ACLS practice and training (p<0.05).
Conclusions: The number of physicians who had sufficient knowledge was low. Factors that influence the ACLS knowledge appeared to be the frequency of ACLS practice and training. From the data gathered,the others recommends that ACLS training program should be incorporated into the routine works of physicians in our hospital in order to increase frequency of ACLS training.
Keywords: advanced cardiac life support; knowledge; physicians; university hospitals
Introduction
Cardiac arrest is one of the most critical conditions found in medical care. It is an emergence, life-threatening conditions which requires rapid responses by an efficient team. Advanced cardiac life support (ACLS) is an important knowledge among physicians to deal with cardiac arrest. ACLS® guideline (American Heart Association guideline 2005 for cardiopulmonary resuscitation and emergency cardiovascular care) was launched in the year 2005.1 The Guideline, which outlines skill and treatment of arrest ACLS to help performance resuscitation in patients, is our hospitals standard practice for cardiac arrest.
Medical staff and residents who practice in high risk areas are required to possess ACLS knowledge and skills. Physicians who have been taught about ACLS knowledge and skill have shown to perform well and, hence, increase survival rate, decrease morbidity and mortality.2-4
At our hospital, physicians, especially the new personnel, have been taught about ACLS in terms of information and skill. They are required to pass ACLS program every year. However, from previous study knowledge and skill on ACLS seem to be waning within 3-6 months after ACLS training.5-6
We studied ACLS knowledge among physicians in our hospital. Data were invaluable to improve training process and we are required to look for new strategies to improved patient care. Our primary objective was to determine whether the physician had sufficient ACLS knowledge. Secondary objective was to survey factors that influenced ACLS knowledge.
Materials and Methods
After receiving approval from institutions research ethics board, we conducted a prospective, descriptive study (between May-July, 2008) at SrinagarindHospital, Faculty of Medicine, KhonKaenUniversity. This study aim was to evaluate ACLS knowledge for future use among medical staff and residents working at Srinagarind Hospital during study period using ACLS test.
The authors team conducted the ACLS test. ACLS instructor evaluated the content validity of the questions. American Heart Association guideline 2005 for cardiopulmonary resuscitation and emergency cardiovascular care was used as a reference. The test (Figure 1), 25 questions, consisted of 4 parts, each aims to evaluate the ACLS knowledge based on the ACLS training program, i.e. 1) knowledge of concept of basic life support (BLS) and ACLS (10 questions), 2) electrocardiogram (ECG) interpretation (5 questions), 3) medication (6 questions), and 4) clinical application (4 questions).
The test has been tested for reliability. Thirty physicians at Khon Kaen provincial center Hospital (tertiary care hospital) have been selected to test the reliability. The data showed that 45% of physician had total score more than 80%. This was the sufficient benchmark for ACLS knowledge.
We included all medical staff and residents who have been working at Srinagarind Hospital during the study period. We enrolled medical staff and residents using stratified random sampling technique by the department. Exclusion criteria were inability to answer the test. After consent has been obtained, the test was given to medical staff and residents to complete within 20 minutes.
We recorded gender, age, department, working duration as demographic data. We also recorded factors that may influence the knowledge and classified into two groups for comparison, i.e. 1) frequency of participation in ACLS in the previous year (< 3 or > 3 times), 2) frequency of ACLS training within 3 years (< 2 or >2 times), 3) duration after ACLS practice (< 0.5 or > 0.5 year), 4) duration since the last ACLS training (< 0.5 or > 0.5 year), and 5) working area (low risk area (eye, general practitioner, radiology, rehabilitation, psychiatry) or high risk area (anesthesiology, internal medicine, obstetrics, orthopedics, otorhinolaryngology, pediatrics, surgery).
Total score and score in each part were recorded. Total score of more than 80% was classified as sufficient ACLS knowledge. Data analysis was performed by using STATA for Windows version 8.0 (Stata Corporation, TX, USA). Sufficient ACLS knowledge was reported as percentage and 95% CI. The mean and SD, median and range were used where appropriated. Chi squares test was used to analyzed the comparison. The sample size required was based on, 1) sufficient ACLS knowledge in pilot study (0.45), 2) a Type I error of 0.05, 3) an absolute precision of 0.11, 4) an 80% power, and 5) population size was 461.
Figure 1 ACLS test Modified from Advanced Cardiovascular Life Support 2005 guideline (American Heart Association).
Results
Seventy physicians were included in the study. Return rate of the test was 100%. Demographic data showed (Table 1). Sufficient ACLS knowledge was 15.7% (95% CI 8.1-26.4) (Table 2). Mean+SD of total score, concept of BLS and ACLS score, ECG interpretation score, medication score, application score were 58.4+21.5, 55.9+26.5, 73.4+26.0, 51.0+23.5, and 57.5+30.3, respectively. Factors that influence the ACLS knowledge was reported (Table 3). Higher frequency of ACLS practice and training showed more proficiency than those with less frequency in ACLS practice and training (p<0.05).
Table 1 Demographic data
Demographic data
Gender (M/F)
33/37
Age (mean+SD; years)
30.9+3.4
Status
Resident
46
Consultant
24
Working duration (median (range))
3 (0.8, 26)
Department (%)
anesthesiology
10.0
eye
7.1
general practitioner
2.9
internal medicine
14.3
obstetric
12.9
orthopedic
8.6
otorhinolaryngology
5.7
pediatric
7.1
radiology
7.1
rehabilitation
5.7
psychiatry
2.9
surgery
15.7
Table 2ACLS score results.
Discussion
Our hospital provides ACLS training program by the CPR unit for medical staff and residents, especially new residents every year. We tested the knowledge and skill after ACLS training. Most of them passed ACLS training program. The program curriculum based on American Heart Association guideline 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. However, the data showed only 15.7% of medical staff and residents in our hospital have sufficient knowledge. Mean+SD in total score is 58.4+21.5. Passing level in our study was 80%, which was higher than previous studies.7 Although passing level depends on the table specification of each test. The ECG interpretation part is where examinees score the highest. Mean+SD of that part is 73.4+26.0. Physicians having always been required to utilize knowledge about ECG interpretation in daily practices may be the of this performance.
Medical staff and residents with higher frequency of ACLS practice have more knowledge than those with less exposure to ACLS practice. Previous data also showed that frequency of ACLS practice is an important factor in maintaining knowledge.7-9 Those who have been trained on ACLS more frequently had more knowledge on the subject than those who have been trained less often. Previous study showed that frequency of ACLS training can improve CPR knowledge.10 Six months apart is the most appropriate duration for ACLS training. Re-training should take place within 3-6 months in order to maintain ACLS skills and knowledge.2, 6, 10 However, our study showed that the duration between ACLS trainings does not show any significance in improving ACLS knowledge. There are multiple factors influencing ACLS knowledge beside the duration between each ACLS training course. From our result, CPR rapid response teams in university hospital are important for ACLS management by experience personnel required to deal the cardiac arrest condition.
Conclusion
Of all the medical staff and residents taken the examinations, 15.7% (95% CI 8.1-26.4) had sufficient knowledge of ACLS. The factor that influenced the ACLS knowledge was frequency of ACLS training. From our data, ACLS training program should be incorporated into works of all physicians at our hospital and there should be more ACLS trainings organized for staff and residents.
Acknowledgement
The authors are grateful for cooperation and assistance of personnel at the CPR unit, Srinagarind Hospital. We are ever so grateful to Emeritus Professor Dr. Somboon SrungBoonmee for his constructive editing of this manuscript.
Reference
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