Challenges and objections to body temperature monitoring among pre-hospital personnel. A modified nominal group technique study.

Abstract

Background: Hypothermia is common and correlates with mortality and morbidity for emergency patients, but a pre-hospital temperature measurement is often omitted. Objectives: To investigate barriers that pre-hospital care (PHC) providers experience with temperature monitoring, and solutions to the problem. Study design: Modified nominal group technique. Materials and methods: Fourteen PHC providers from air and ground services were invited to the study. Initially, each participant was asked to suggest through e-mail topics of importance regarding barriers to pre-hospital thermometry. Afterwards, they received a list of all disparate topics, and were asked to individually rank the topics after importance. The top ranked topics were discussed in a consensus meeting. The meeting was audio-recorded, and a transcript was written and then analyzed through an inductive thematic analysis. Results: Thirteen participants accepted the invitation. 63 suggestions were reduced to 24 disparate topics after removal of duplicates. Twelve highly ranked topics were discussed during the consensus meeting. Thematic analysis revealed 47 codes that were grouped together into six overarching themes, of which four described challenges to monitoring and two described potential solutions: Equipment dissatisfaction, little focus on patient temperature, fear of iatrogenic complications, thermometry is subordinated, more focus on temperature, and simplification of thermometry. Conclusion: To increase the rate of temperature measurement on correct indication, we suggest introducing PHC protocols that specify patients and conditions where proper temperature measurement should have a high priority. Furthermore, there is a profound need for more suitable techniques for temperature monitoring in the pre-hospital setting.