Frontline barriers to effective paramedic and emergency nursing STEMI management: clinician perspectives

Abstract

Background: Factors that hinder the pivotal role frontline clinicians play in STEMI management are under-reported. We aimed to explore perceived barriers to effective STEMI management by addressing the following questions: 1. What are the most commonly occurring barriers to timely STEMI management for paramedics and emergency nurses? 2. Are there differences in barriers experienced by paramedics and emergency nurses? 3. Are there differences in barriers experienced by frontline clinicians in rural and metropolitan settings?

Methods: A 79-item online survey was offered to paramedics and emergency nurses. Descriptive statistics and exploratory factor analysis identified the most frequently experienced types of barriers. Professional groups and geographical locations were compared.

Results: There were 333 respondents. Response rates for paramedics was 10% and 9% for members of an emergency nursing association. Most commonly occurring barriers across all respondents were: 'lack of skills development'; 'lack of feedback'; 'untimely support'; 'distance to scene/hospital facilities'; 'hospital-related delays'. Statistically significant differences were found by professional group and geographical location.

Conclusion: Barriers to timely management were present, but not frequently experienced. Survey responses indicate a need for improved continuing professional development opportunity, clearer feedback mechanisms, streamlined facilitation of STEMI processes in hospitals, and enhanced access to expert advice/resources for all frontline clinicians.

Keywords: Emergency medical services; Emergency nursing; Implementation science; Interdisciplinary communication; ST elevation myocardial infarction; Survey and questionnaires.