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Perceived factors influencing healthcare professionals' adherence to the ABCDE approach: an exploratory explanatory
Marjolein Linders1, Nino H C Schoeber2, Mathijs Binkhorst2
1Department of Paediatrics, Amalia Children's Hospital, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.
Background:
The Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is considered the preferred way to assess potentially critically ill patients. This study aimed to identify perceived factors influencing healthcare professionals' adherence to the ABCDE approach.
Methods:
An exploratory, explanatory sequential mixed-methods study was performed, comprising an cross-sectional questionnaire phase followed by semi-structured focus groups. A total of 239 healthcare professionals (nurses, nurse practitioners, physician assistants, residents and medical specialists) from six disciplines (Anaesthesiology, Emergency Medicine, Paediatrics and the Neonatal, Paediatric and Adult Intensive Care Units) filled out a questionnaire. Questionnaire results were analysed and used as input for five semi-structured focus groups with 22 participants. The focus groups were transcribed and analysed using template analysis, complemented by identification of additional themes.
Results:
Perceived factors influencing adherence to the approach were categorised into five domains: guideline, individual health professional, patient, professional interactions, and incentives/resources. The importance of the ABCDE approach was affirmed, with 95.4% recognising it as their responsibility to perform the approach. Confidence in competency was high with a median rating of 90% (IQR 80-99) on a 0-100% scale. While feedback was considered valuable, 68.2% indicated it was provided rarely. Other identified factors included the ABCDE approach's simplicity and structure, healthcare professionals' experience, patient condition, the presence of a predefined team leader, and the role of regular education. 'Context dependency', 'ABCDE as a language' and 'Personal value' were identified as additional themes.
Conclusions:
This study identified perceived factors influencing healthcare professionals' adherence to the ABCDE approach. Adequate application of the ABCDE approach may require continuous learning in education and clinical practice.
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