Rib Fixation for Multiple Rib Fractures: Healthcare Professionals Perceived Barriers and Facilitators to Clinical Implementation.

Autor: Spronk I; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands. i.spronk@erasmusmc.nl., Van Wijck SFM; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands., Van Lieshout EMM; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands., Verhofstad MHJ; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands., Prins JTH; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands., Wijffels MME; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands., Polinder S; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2023 Jul; Vol. 47 (7), pp. 1692-1703. Date of Electronic Publication: 2023 Apr 04.
DOI: 10.1007/s00268-023-06973-y
Abstrakt: Background: Surgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For multiple rib fractures, the benefit of SSRF remains a topic of debate. This study investigated barriers and facilitators of healthcare professionals to SSRF as treatment for multiple traumatic rib fractures.
Methods: Dutch healthcare professionals were asked to complete an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators of SSRF. If ≥ 20% of participants responded negatively, the item was considered a barrier, and if ≥ 80% responded positively, the item was considered a facilitator.
Results: Sixty-one healthcare professionals participated; 32 surgeons, 19 non-surgical physicians, and 10 residents. The median experience was 10 years (P 25 -P 75 4-12). Sixteen barriers and two facilitators for SSRF in multiple rib fractures were identified. Barriers included lack of knowledge, experience, evidence on (cost-)effectiveness, and the implication of more operations and higher medical costs. Facilitators were the assumption that SSRF alleviates respiratory problems and the feeling that surgeons are supported by colleagues for SSRF. Non-surgeons and residents reported more and several different barriers than surgeons (surgeons: 14; non-surgical physicians: 20; residents: 21; p < 0.001).
Conclusion: For adequate implementation of SSRF in patients with multiple rib fractures, implementation strategies should address the identified barriers. Especially, improved clinical experience and scientific knowledge of healthcare professionals, and high-level evidence on the (cost-) effectiveness of SSRF potentially increase its use and acceptance.
(© 2023. The Author(s).)
Databáze: MEDLINE
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