Abstract 328: Translating Guidelines into Practice: A Survey Study to Assess Healthcare Provider Attitudes, Preferences and Beliefs Regarding Pediatric Fluid Resuscitation Practices

Abstract

Introduction: Children who require fluid resuscitation for the treatment of shock present to tertiary and non-tertiary medical settings. While timely fluid therapy improves survival odds and is accepted as a key component of initial resuscitative care, guidelines are poorly translated into clinical practice. Objective: To characterize the attitudes, preferences and beliefs of health care providers regarding pediatric fluid resuscitation practices. Hypothesis: Varying attitudes and beliefs concerning pediatric fluid resuscitation performance would exist among providers who frequently resuscitate children. Methods: A single-centre survey study was conducted at McMaster Children’s Hospital from January to May, 2012. The sampling frame (n=111) included nursing staff, physician staff and subspecialty trainees working in Pediatric Emergency Medicine (PEM) or Pediatric Critical Care Medicine (PCCM). A self-administered questionnaire was developed and assessed for face validity prior to distribution. Eligible participants were invited at 0, 2, and 4 weeks to complete a web-based version of the survey. A follow-up survey administration phase utilizing a tablet-based version of the survey was conducted to improve the response rate. Results: Response rate was 75% (83/111), with 83% identifying themselves as nursing staff and 61% as PCCM providers. Resuscitation experience, frequency of shock management, and years in specialty, were similar between PCCM and PEM responders. Physicians and nurses had differing opinions regarding the most effective method to achieve rapid fluid resuscitation in young children presenting in shock (p<0.001). Disagreement also existed regarding the age and size of patients in whom rapid infuser devices, such as the Level-1 Rapid Infuser, should be used (p<0.001). Providers endorsed a number of potential concerns related to the use of rapid infuser devices in children, and only 14% of physicians and 55% of nursing staff felt that they had received adequate training in the use of such devices (p=0.005). Conclusions: There is a lack of consensus among health care providers regarding how pediatric fluid resuscitation guidelines should be operationalized, supporting a need for further work to define best practices.