Intraosseous Drug Administration is Associated With Lower Survival in Out-of-Hospital Cardiac Arrest
Academic Emergency Medicine
Background: Poor outpatient follow up and care coordination for patients discharged from the emergency department (ED) contributes to ED overuse and adverse health outcomes. This study examined the feasibility and efficacy of a behavior change intervention on outpatient follow-up rates and health outcome among low-risk chest pain (LRCP) patients presenting to an urban tertiary ED. Methods: Using a randomized control trial design, LRCP patients presenting to the ED were randomized to either controls (the institution’s standard of care (SoC)) or intervention group, which consisted of SoC plus a brief education and motivational interviewing-based intervention designed to increase patient activation and motivation for attending recommended outpatient cardiology visits at an affiliated cardiology clinic (CTO). Measures of outpatient follow-up and adverse health outcomes (primary outcomes) were collected one-week and 60-days respectively post ED discharge. Data to examine patient motivation and activation were collected at two time points (pre-post design) prior to participant discharge from the ED. Results: A total of 102 patients were randomized (n = 50 intervention; n = 52 controls). Sample demographics were as follows: mean age: 49.6 years; 57% male; 90% African American. No significant group differences were found for demographic variables, with the exception of housing status. The intervention group had a higher proportion of individuals living with relatives or friends (20% vs 4% for SoC) (p = 0.0121). Though the intervention group had higher rates of out-patient follow-up compared to controls ,78.9% vs 66.7%, the difference was not statistically significant (p = 0.4756). Neither group experienced deaths or major adverse cardiac events. Analysis of secondary outcomes showed significant improvements in the intervention group with respect to patient activation (p = 0.0011), motivation to follow up (p = 0.0042), and participant understanding of the value of CTO follow up (p < 0.0001) compared to controls. Conclusion: The significant observed differences in both patient activation and motivation, and the positive trend in increased outpatient follow-up suggests that a brief, ED based intervention may hold promise for improving adherence to outpatient follow-up and associated outcomes. Additional research among a more robust sample is warranted.
Hamam M, Miller J, France J, Otero R, Swor R et al. Intraosseous drug administration is associated with lower survival in out of hospital cardiac arrest. Acad Emerg Med 2019; 26:S155.