Attitudes of Australian emergency department clinicians toward organ and tissue donation: an analysis of cultural and religious influences.

OBJECTIVES: To determine Australian emergency department clinicians' cultural and religious barriers to organ and tissue donation (OTD). METHOD: A national cross-sectional survey of physicians and nurses working in Australian emergency departments. An online questionnaire of 133 items was delivered via e-mail. RESULTS: Responses were received from 599 of 2969 (20%) physicians and 212 of 1026 (21%) nurses. Respondents were generally representative of the colleges. Participants were from 26 cultures and 9 religious groups. Self-rated competence in OTD tasks was low for some minority groups: South American, Caribbean, and Pacific Islanders reported little competence in identifying, referring, and caring for potential donors, introducing OTD to families, and approaching distressed families. Those of Arabic, Jewish, North African, and Middle Eastern background reported low competence in referring and caring for potential donors and comforting distressed families. They reported low support for OTD after cardiac death, low familiarity with OTD processes after cardiac death, and poor familiarity with the coroner's process. Those of Southern Asian background reported low comfort in undertaking OTD processes, poor familiarity with the coroner's process, and low competence in caring for potential donors. Those of Islamic faith reported low competence in identifying potential donors, low support for OTD after cardiac death, and thought that the emergency department was an inappropriate location to identify potential donors. Those of Buddhist and Hindu faiths reported low competence in identifying potential donors. Respondent numbers for members of minority groups were low, thereby limiting the statistical accuracy of results. CONCLUSIONS: Among clinicians working in Australian emergency departments, religion and culture may be barriers to facilitating OTD in emergency departments because of the perceptions and attitudes held by particular religious and cultural groups. Improving access to education may address these differences.

Resource barriers to the facilitation of organ and tissue donation reported by Australian emergency clinicians.

OBJECTIVE: To explore emergency department clinicians' perceived resource barriers to facilitating organ and tissue donation (OTD). METHODS: A cross-sectional national online survey of Australian emergency department (ED) clinicians. RESULTS: ED clinicians reported a range of resource barriers that hinder the facilitation of OTD, most notably a lack of time to discuss OTD with a patient's family (74.6%). Those reporting more resource barriers had been less involved in OTD-related tasks. For example, those reporting a lack of time to assess a patient's suitability to be a potential donor had less experience with OTD-related tasks in the last calendar year than did those who reported that they often or always have enough time for this (P<0.01). In addition, ED clinicians working in DonateLife network hospitals were more involved in OTD-related tasks (P<0.01) and reported fewer resource shortages in the ED and the hospital overall. CONCLUSIONS: Resource shortages hinder the facilitation of OTD in the ED and are related to decreased involvement in OTD-related tasks. In addition, ED clinicians working in DonateLife hospitals are more involved in OTD-related tasks and report fewer resource shortages overall. Addressing resource shortages and extending the DonateLife network could benefit OTD rates initiated from the ED.

Australian emergency clinicians' perceptions and use of the GIVE Clinical Trigger for identification of potential organ and tissue donors.

OBJECTIVES: In 2010 the Australian Organ and Tissue Authority introduced a nationally consistent indicator, the GIVE Clinical Trigger, for early identification of potential organ and tissue donors in EDs and intensive care units. This national survey of emergency clinicians aimed to assess emergency clinicians' perceptions and use of the Trigger. METHODS: National cross-sectional survey of Australasian College for Emergency Medicine (ACEM) fellows and trainees and members of the College of Emergency Nursing Australia (CENA); online questionnaire; 12 items addressing implementation of the GIVE Trigger; graded and free-text responses. RESULTS: Five hundred and ninety-nine (20.2%) of 2969 ACEM members and 212 (20.7%) of 1026 CENA members responded. Four hundred and seventy-four respondents (62.7%) were familiar with the Trigger; 472 (63.8%) agreed it was easy to recognise patients who activated the Trigger; 490 (64.9%) had sufficient time to use the Trigger; 511 (67.7%) felt they had the necessary competence and knowledge to identify a potential donor; 464 (61.5%) felt competent and 501 (66.4%) felt comfortable referring a potential donor when identified. Overall 587 (77.7%) ED clinicians supported the use of the Trigger, but most (587 [77.7%]) perceived barriers to its use; 628 (80%) had never activated the Trigger and 557 (71%) had never referred a potential donor to relevant authorities. CONCLUSION: Most Australian emergency clinicians are familiar with and support the GIVE Clinical Trigger, and feel they have the necessary skills to use the Trigger; however, most perceive barriers to its use and have not yet used the Trigger.

Personal attitudes and beliefs regarding organ and tissue donation: a cross-sectional survey of Australian emergency department clinicians.

CONTEXT: Resources are currently targeted at increasing organ and tissue donation rates from emergency departments in Australia. Health care professionals' beliefs and personal attitudes regarding organ and tissue donation are known to influence professional attitudes and practice. OBJECTIVE: To assess emergency department clinicians' general beliefs and personal attitudes toward organ and tissue donation, how general beliefs influence personal attitudes, and which demographic characteristics are related. DESIGN: A cross-sectional online survey, based on available literature and the validated and widely used Hospital Attitude Survey (DonorAction). PARTICIPANTS: Data were collected from 811 Australian emergency department clinicians, invited to participate through the College of Emergency Nursing Australasia, and the Australasian College for Emergency Medicine. RESULTS: Most clinicians were very supportive of organ and tissue donation (96.2%), believed that organ and tissue donation can save lives (98.5%), and that organs and tissues will be allocated fairly (82.6%); however, 30.1% did not agree that organ and tissue donation can help the next of kin cope with grief. Holding positive general beliefs increased positive personal attitudes toward organ and tissue donation (P < .001). Most reported willingness to donate their own organs and tissues after death (90%) and give family consent for their children (79.6%) or adult family (86.6%) member to donate. Eighty-six percent had discussed their wishes with next of kin, but only 50.7% had registered on the Australian Organ Donor Register. Older clinicians, male clinicians, and clinicians of certain religious and cultural backgrounds were identified as having less positive general beliefs and personal attitudes. CONCLUSION: Although Australian emergency department clinicians are generally positive toward organ and tissue donation, some groups could potentially benefit from education to change their beliefs and attitudes about organ and tissue donation further.

Organ and tissue donation-related attitudes, education and practices of emergency department clinicians in Australia.

OBJECTIVE: The ED is emerging as a priority for efforts to improve rates of organ and tissue donation (OTD) in Australia, but little is known of ED clinicians' attitudes, education or practices in the area. We aimed to determine the attitudes and OTD-related educational background and practices of Australian ED clinicians. METHODS: This was a national cross-sectional survey of members of the Australasian College for Emergency Medicine (ACEM) and the College of Emergency Nursing Australasia (CENA); online questionnaire of 133 items, graded responses using Likert and ordinal multi-category scales, plus open-ended qualitative questions. RESULTS: Of 2969 ACEM members, 599 (20.2%) responded; of 1026 CENA members, 212 (20.7%) responded. Respondents were broadly representative of the membership, with male trainee specialists underrepresented. Most ED staff supported OTD, although many were not certain that facilitating OTD was their role, or that the ED was the right place to identify donors. Around a quarter of medical and nursing staff had received no education regarding OTD. Having received education was related to professional status, cultural background, place of work and years of experience, and was significantly associated with attitude towards OTD and whether staff participated in OTD-related tasks. CONCLUSIONS: More education on OTD is needed and requested by ED clinicians in Australia, particularly on OTD after cardiac death, management of a donor, brain death and obtaining consent. Postgraduate curricula should reflect this need for more OTD-related education in emergency medicine and nursing.

Australian emergency doctors' and nurses' acceptance and knowledge regarding brain death: a national survey.

Healthcare staff's acceptance of brain death (BD) being a valid determination of death is essential for optimized organ and tissue donation (OTD) rates. Recently, resources to increase Australian OTD rates have been aimed at emergency departments (ED) as a significant missed donor potential was discovered. A cross-sectional survey was conducted to assess Australian ED clinicians' acceptance and knowledge regarding BD. Most (86%) of the 599 medical and 212 nursing staff accepted BD, but only 60% passed a 5-item-validated BD knowledge tool. BD knowledge was related to the acceptance of BD. Accepting BD influenced attitudes toward OTD, including willingness to donate. BD acceptance and knowledge were related to education/training regarding OTD, years of experience in EDs, experience with OTD-related tasks, and increased perceived competence and comfort with OTD-related tasks. Of concern, more than half of respondents who did not pass the BD test reported feeling competent and comfortable explaining BD to next of kin; of respondents who had recent experience with this, more than a third failed the BD test. Despite being generally positive toward OTD, Australian ED clinicians do not have a sound knowledge of BD. This may be hampering efforts to increase donation rates from the ED.

Automated external defibrillators and in-hospital cardiac arrest: patient survival and device performance at an Australian teaching hospital.

AIMS: To evaluate the effect of automated external defibrillators (AEDs) on patient survival and to describe the performance of AEDs after in-hospital cardiac arrest. METHODS: Prospectively collected data were analysed for cardiac arrests in the general patient care areas of a teaching hospital during the 3 years before and the 3 years after the deployment of AEDs. The association between availability of an AED and survival to hospital discharge was assessed using multivariate logistic regression. AED performance during automated management of the initial rhythms was assessed using information captured by the AEDs. RESULTS: There were 84 cardiac arrests in the AED period and 82 in the pre-AED period. Patient and event characteristics were similar in each period. The initial rhythm was shockable in 16% of cases. Return of spontaneous circulation was higher in the AED period (54% vs. 35%, P=0.02) but the proportion of hospital survivors in each period was similar (22% vs. 19%, P=0.56). The adjusted odds ratio for hospital survival when an AED was available was 1.22 (95% CI 0.53-2.84, P=0.64). An AED was applied in 77/84 (92%) possible cases. Median interruption to chest compressions was 12s (inter-quartile range 12-13). An automated shock was delivered in 8/13 (62%) possible cases. CONCLUSIONS: Availability of AEDs was not independently associated with hospital survival. Shockable presenting rhythms were not common and, in keeping with the manufacturer's specifications, the AEDs did not shock all potentially shockable rhythms. The hands-off time associated with automated rhythm management was considerable.

Automated external defibrillators and survival after in-hospital cardiac arrest: early experience at an Australian teaching hospital.

OBJECTIVE: To evaluate the effect of the introduction of automated external defibrillators (AEDs) on survival after inhospital cardiac arrest. DESIGN, SETTING AND PARTICIPANTS: Before-and-after study that compared patients during the 2 years before (8 November 2005 to 7 November 2007) and the year after (8 November 2007 to 7 November 2008) the deployment of AEDs to the non-critical care areas of a university teaching hospital. MAIN OUTCOME MEASURES: Return of spontaneous circulation (ROSC) and survival to hospital discharge. RESULTS: 55 in-hospital cardiac arrests occurred in the 2-year pre-AED period and 31 in the 1-year AED period. Patients had similar baseline characteristics in the pre-AED and AED periods including witnessed arrest (53% v 48%), arrest in an acute inpatient ward (78% v 90%), and initial arrest rhythm of pulseless ventricular tachycardia or ventricular fibrillation (18% v 16%). The proportions of patients with ROSC were similar in the pre-AED and AED periods (42% v 55%), as were the proportions who survived to hospital discharge (22% v 29%). In the AED period, the relative risk of ROSC was 1.31 (95% CI, 0.84- 2.04) and the relative risk of survival to hospital discharge was 1.33 (95% CI, 0.63-2.80). CONCLUSIONS: ROSC and survival to hospital discharge did not change significantly after deployment of AEDs. The existence of a timely and robust resuscitation response with relatively good baseline outcomes, and the low proportion of initial shockable arrest rhythms may have limited the capacity of AEDs to improve survival.