Perfusionists Research Articles

Perfusion Recruitment Strategies Using Choice-Based Conjoint Analysis.

Perfusionists are leaving the workforce in higher rates as baby-boomers retire, yet the volume of cases involving perfusion continues to increase. This change has resulted in a high-demand market with organizations competing for the same candidates. The purpose of this study was to use a choice-based conjoint (CBC) analysis to determine what attributes of employment opportunities are most important to perfusionists so hiring organizations are better equipped to produce employment offers specific to each candidate. The Sawtooth Software Discover program was used to create a CBC survey that was distributed to perfusionists. After a series of demographic questions, respondents chose between three employment offers that comprised eight attributes, each with three varying options. Completed surveys were analyzed using the Discover software, producing importance scores. Two hundred forty surveys were completed, 154 (64%) male and 86 (36%) female. Extracorporeal membrane oxygenation (ECMO) impact to the perfusionist and hours worked per week ranked most important, at 19.4% and 17.5%, respectively. A significant difference exists between ECMO impact to perfusionists and all other attributes. The least important attributes were annual continuing education funds and sign-on bonus/relocation, at 6.8% and 4.7%, respectively. Respondents in their 20s and 30s find the importance of ECMO impact to be significantly less important than those in their 50s. Perfusionists with a master's degree believe salary to be significantly more important than perfusionists with other types of perfusion education. Based on the respondents who completed this survey, the impact ECMO has on the perfusionist was the most significant job attribute. Offering large sign-on bonuses and relocation packages to entice new employees is not indicated as a viable way to satisfy perfusionists. Appropriate management of hours worked, days on call, and how ECMO impacts the perfusionists will be most impactful in recruitment of new employees.

Survey of the Routine Practice Limits for Physiologic and Technical Parameters Managed by Clinical Perfusionists during Adult Cardiopulmonary Bypass.

Cardiopulmonary bypass (CPB) is a highly technical clinical discipline with a recognized variability in practice. Professional standards and guidelines documents help direct clinical practice and reduce variability, but these guidelines are necessarily vague and fall short of providing specific objective recommendations of clinical practice metrics. If clinical practice metrics were known, they would be informative when writing departmental policy manuals, structuring quality improvement initiatives, describing product R&D specifications, and designing educational assessment rubrics. Therefore, to address this gap, we conducted a national survey of clinical practice with the purpose of producing a benchmark of the typical variability of specific technical parameters that are commonly managed during adult CPB procedures. A pool of expert clinical perfusionists collaborated to compile a data set of normal ranges for 41 individual physiologic and technical parameters (pressures, flows, saturation, times, solutions, and temperatures) that are commonly managed during adult CPB procedures. Results were collected using an online survey application. Respondent demographics and measures of central tendency with descriptive quartile statistics and confidence intervals for each parameter are presented. Of the 335 people who participated in the survey, 315 met the inclusion criteria. The geographic demographics of the respondents were representative of the American Board of Cardiovascular Perfusion's distribution of certified clinical perfusionists. Of the 41 parameters investigated, there were 13 hemodynamic parameters, 13 normal flow rates and technical circuit parameters, 10 blood gasses and hematocrit parameters, and five parameters of patient temperatures. The data presented here are informative and provide a consensus-based objective assessment of the standard practice for adult CPB as reported by practicing clinical perfusionists. Based on these survey data, we have identified the typical clinical limits for the 41 parameters that are managed during adult CPB. This information may be incorporated into guiding documents to support the work of clinicians, researchers, and educators.

Development of an Electronic Medical Record for Extracorporeal Membrane Oxygenation and Its Role in a Multidisciplinary Team.

As the extracorporeal membrane oxygenation (ECMO) program at our institution has grown and our staffing model has evolved into a multidisciplinary team, our method of ECMO charting has also evolved, using an electronic medical record (EMR) with electronic checklists, progress notes, and remote access. Using our EPIC charting platform, version 1 of our EMR was implemented in 2015. It has been revised three times, and remote access deemed necessary to properly support our staff and patients. Our current, yet still evolving, remotely accessible, ECMO EMR incorporates hourly charting and protocol-based checklists for procedures such as initiation of support, shift handoffs, circuit checks, and patient transport. Perfusionists are required to fill out thrice daily progress notes, notes for bedside/operating room procedures, and patient transport. We present a format for centers looking to implement a comprehensive EMR for ECMO patients. An expanding ECMO program required a change to our staffing model, and an EMR with electronic checklists and remote access facilitated the transition to a multidisciplinary team. Protocol-based checklists ensure consistency during procedures, transports, and shift changes. The remote access and required progress notes create a safer team approach and keep our perfusionists engaged when specialists are sitting ECMO.

Development of the Adult ECMO Specialist Certification Examination.

The American Society of Extracorporeal Technology Board of Directors, consistent with the American Society of Extracorporeal Technology's safe patient care improvement mission, charged the International Board of Blood Management to write a knowledge and skill certification examination for healthcare personnel employed as adult extracorporeal membrane oxygenation (ECMO) specialists. Nineteen nationally recognized ECMO subject-matter experts were selected to complete the examination development. A job analysis was performed, yielding a job description and examination plan focused on 16 job categories. Multiple-choice test items were created and validated. Qualified ECMO specialists were identified to complete a pilot examination and both pre- and post-examination surveys. The examination item difficulty and candidate performance were ranked and matched using Rasch methodology. Candidates' examination scores were compared with their profession, training, and experience as ECMO specialists. The 120-item pilot examination form ranked 76 ECMO specialist candidates consistent with their licensure, ECMO training, and clinical experience. Forty-three registered nurses, 28 registered respiratory therapists, four certified clinical perfusionists, and one physician assistant completed the pilot examination process. Rasch statistics revealed examination reliability coefficients of .83 for candidates and .88 for test items. Candidates ranked the appropriateness for examination items consistent with the item content, difficulty, and their personal examination score. The pilot examination pass rate was 80%. The completed examination product scheduled for enrollment in March 2020 includes 100 verified test items with an expected pass rate of 84% at a cut score of 67%. The online certification examination based on a verified job analysis provides an extramural assessment that ranks minimally prepared ECMO specialists' knowledge, skills, and abilities (KSA) consistent with safe ECMO patient care and circuit management. It is anticipated that ECMO facilities and ECMO service providers will incorporate the certification examination as part of their process improvement, safety, and quality assurance plans.

Incident Reporting in Perfusion: Current Perceptions on PIRS-2.

The Australia and New Zealand College of Perfusionists' (ANZCP) Perfusion Incident Reporting System was established in 1998 and has evolved to an open access on-line incident perfusion reporting system (PIRS-2). Changes were made to PIRS-2 to promote learning from what went well in unexpected situations. A 9-question survey was e-mailed to the PIRS-2 contact group to elicit feedback on attitudes to voluntarily reporting perfusion-related incidents and near-miss events to PIRS-2. In August 2019, a 9-question survey using SurveyMonkey® (San Mateo Ca) was e-mailed to 198 perfusionists currently on the ANZCP PIRS-2 e-mail contacts group. Responses for all responding practicing perfusionists were totaled and expressed as a percentage of the total number of respondents. The respondents were then grouped by region and responses were expressed as a percentage of respondents from each region as well as for grouped responses from Australia/New Zealand (ANZ) and non-ANZ respondents. The response rate was 49.5% with 95 practicing perfusionists completing the survey. In the 12 months before the survey, 22% of respondents had submitted reports to PIRS-2, whereas 79% had read e-mailed reports. Unit culture was the most frequently cited barrier to reporting from all respondents (19%; 0% to 40% by region). Twenty-five percentage of Australian respondents cited unit culture as a barrier to reporting vs. 0% of New Zealand respondents. A combination of concern of discovery and identification of region ranked second as a barrier for 17% of all respondents. The open access ANZCP PIRS-2 voluntary incident reporting in perfusion was widely viewed as relevant and beneficial to both individual practice and to team performance. A high likelihood to considering reporting incidents is tempered by the well-established barriers of ease of the reporting system, the fix and forget phenomenon, concerns of discovery, and a defensive unit culture.

Results of the 2019 Survey on Perceptions of Vacancy and Turnover Among Perfusionists in the United States.

A large number of recent publications and presentations have focused on impending workforce issues that surround the field of perfusion. Vacancy and turnover rates, which provide a picture of the current workforce status and serve as a benchmark for comparison with past and future equilibrium, have not been examined. The purpose of the 2019 Vacancy and Turnover study was to identify current staffing trends among a cohort of perfusionists in the United States, as well as the factors affecting these trends. A vacancy and turnover survey was conducted during January and February of 2019. The survey required participants to answer several questions designed to determine vacancy and turnover during the prior 1-year period. Questions related to the vacancy and turnover rates of perfusionists were reported with descriptive statistics, including the means, medians, standard deviations, and range of scores. The study collected 502 responses, of which 484 met all inclusion criteria. Vacancy and turnover rates were analyzed by state, region, employer type, group size, and salary range. In summary, the vacancy rate for all perfusion groups in this survey was 12.3%, with a turnover rate of 14.7%. This investigation explores differences in vacancy and turnover among different subgroups based on state, region, employer, practice size, and salary range. Data from this study are presented as a guide to assist stakeholders in determining the best course of action with regards to staffing of perfusion services and how to plan for future needs.

Exploring the multiple disciplinary model of emergent extracorporeal membrane oxygenation for cardiac arrest patients

Objective To explore the multiple disciplinary model of emergent extracorporeal membrane oxygenation (ECMO) for cardiac arrest (CA) patients. Methods A retrospective investigation was done to analyze the general material, multiple disciplinary corporations, the complication and its treatment of patients who underwent emergent ECMO for non-surgery CA from January 2016 to August 2017. Results Three patients were all men with mean age 45.3±20.3 years. Their mean cardiopulmonary resuscitation duration was 34±10 min, and 2 patients returned to spontaneous circulation, yet hemodynamics instability. 2 patients discharged with cerebral performance category 1-2, however the third died. 3 cannulation of femoral artery and venous were all operated by cardiac surgery using surgical exposure via open cutdown. Mean duration of CA to ECMO pump-on was 132±93 min, while the mean duration of ECMO was 3 858±1 092min. The implementation and maintenance of ECMO needed collaboration of emergent physicians, cardiovascular medicine and surgeon, anesthetists, nurses and so on. At the same time, incision site oozing blood, platelet counting decreasing, coagulopathy and other complications would occur, which needed interventional vascular surgeon and blood bank to participate in. Conclusions Emergent ECMO for CA patients need corporations of prehospital emergent medical system, emergent physicians, cardiovascular physicians and surgeons, anesthetists, perfusionists, blood bank and so on. Establishing coordination and cooperation model of multiple disciplinary quick response team with emergency department as the guide is the important guarantee for emergent department developing emergent extracorporeal resuscitation. Key words: Cardiac arrest; Emergent extracorporeal membrane oxygenation; Multiple disciplinary networks; Model

Compliance of Iranian perfusionist with the American Society of extracorporeal technology standards

Background: Standards play an important role in representing the minimum favorable and acceptable performance and are used in determining the exact current status of a hospital and evaluating and monitoring its performances. Standards also play an important role in providing quality services by perfusionists to patients undergoing open heart surgery with heart–lung machine. Objectives: This study aimed to analyze the compliance with standards related to perfusionists in Iran by comparison with the American Society of Extracorporeal Technology Standards. Methods: In this descriptive cross-sectional study, a questionnaire developed by the American Society of Extracorporeal Technology Standards was used to collect data from 48 Iranian hospitals and educational medical centers. The level of compliance with perfusion standards related to perfusionists was analyzed and compared with the American Society of Extracorporeal Technology Standards. Results: The results showed that 45.52% of the centers were in compliance with factors related to standards of competence, qualification, and backup staffing for critical situation. Only 23% of the centers comply with standards of perfusionists' interaction with the medical team which indicates an unsatisfactory interaction between perfusionists and the medical team, and regarding the working hours, only 18.5% of the centers comply with the standards in this area. Conclusion: The comparison made between the compliance of Iranian perfusionists and the American Society of Extracorporeal Technology Standards reveals an unsatisfactory level. This suggests the need for the development of accreditation programs and standards of care on the one hand and conduction of a continuous evaluation of these standards on the other hand.

Commencing open heart surgery in resource limited countries: lessons from the LASUTH experience.

The challenge of commencing cardiac surgery in developing countries of Africa is onerous. We present a model from the experience of carrying out open cardiac surgical procedures at the Lagos State University Teaching Hospital (LASUTH) with three separate missions between 2004 and 2006. This paper details the challenges of starting open heart surgery in a resource limited environment. We propose that owing to the huge financial investment needed, government sponsorship as well as collaboration with overseas based and local non-governmental agencies may be required to jump start the process of open cardiac surgery. Local staff training opportunities are also provided by such missions and this can further be complemented by overseas exposure in areas of need for capacity building. In our centre, the initial investment has led to the recruitment of additional trained staff including 2 cardiothoracic surgeons. Further benefits of training of 2 perfusionists and a nurse has improved capacity in cardiac surgery service at our center.

Perfusionist Education in Turkey and in the World

Perfusionist Education in Turkey and in the World

ECMO — a perfusionist's view

ECMO — a perfusionist's view