Clinician Perspectives of Barriers and Enablers to Quality Cardiogenic Shock Care: A Focus Group Study

Abstract

Background & Aim

Cardiogenic shock is a medical emergency that is associated with high mortality rates. It is a resource-intensive and costly condition that is complicated by comorbidities and clinical deterioration. However, the barriers and enablers to quality cardiogenic shock care are relatively unknown from the perspective of Australian clinicians. This study aimed to i) To explore clinicians’ perspectives on the barriers to delivering these best practice care and optimal outcomes for patients with cardiogenic shock; and ii) To understand priorities to overcome these barriers, with the intent of using the findings to inform the development and implementation of a clinical trial for cardiogenic shock management—ESCAPE-CS: Evaluation of a Standardised ClinicAl Pathway to improve Equity and outcomes in Cardiogenic Shock (ESCAPE-CS).

Method

A qualitative focus group study was conducted via videoconference with experienced clinicians, and audio-recorded and transcribed verbatim. Data were analysed using thematic analysis in NVivo.

Results

Five focus groups were conducted, including 19 participants (11 male and eight female), comprising seven intensive care unit physicians, seven nurse consultants/educators, three cardiologists, and two emergency department physicians working in metropolitan and rural, regional, or remote health settings. Five themes were identified:

• 1)
  Referral and retrieval pathways and systems;
• 2)
  The importance of clinical recognition and response to deterioration;
• 3)
  Geographical differences in resources and expertise;
• 4)
  Increased inter-disciplinary collaborations; and
• 5)
  The use of guidelines, data, and protocolised care and technologies.

Conclusions

This study provided critical insights into the barriers and possible enablers to delivering best practice care and optimal outcomes for patients with cardiogenic shock. There is scope for an improved model of care in cardiogenic shock management to address inequalities emerging from multifactorial complexities.