# Implementation of a specialized neuroprognostication consultation program and associated provider attitudes: A survey-based study

## TL;DR

A specialized neuroprognostication program improved provider attitudes and satisfaction with neuroprognostication after cardiac arrest.

## Contribution

A novel interdisciplinary program was implemented and shown to improve provider perceptions of neuroprognostication.

## Key findings

- Program-exposed providers reported greater usefulness of neuroprognostication compared to historical and contemporary controls.
- Providers expressed higher satisfaction with the program compared to conventional models.
- The program was perceived as more comprehensive by participants.

## Abstract

•Does a specialized neuroprognostication program improve provider perceptions?•We disseminated surveys to critical care providers over three years.•Surveys assessed attitudes and satisfaction with post-arrest neuroprognostication.•The program was associated with improved provider attitudes and satisfaction.•A specialized program may help improve neuroprognostication after cardiac arrest.

Does a specialized neuroprognostication program improve provider perceptions?

We disseminated surveys to critical care providers over three years.

Surveys assessed attitudes and satisfaction with post-arrest neuroprognostication.

The program was associated with improved provider attitudes and satisfaction.

A specialized program may help improve neuroprognostication after cardiac arrest.

Neuroprognostication for disorders of consciousness, particularly after cardiac arrest, is critical. However rapidly evolving research has translated little to clinical practice, with neuroprognostication frequently deviating from evidence and clinical guidelines. We implemented a novel program that provides specialized, interdisciplinary, and longitudinal care to improve the practice of neuroprognostication. The objective of this study was to evaluate the impact of this program on provider attitudes and satisfaction towards neuroprognostication after cardiac arrest.

We disseminated surveys across our health system to critical care providers and neurologists in the years before (2021, 2022) and after (2023) implementation of the program. The surveys assessed perceptions of, and satisfaction with, neuroprognostication after cardiac arrest. We used Fisher exact tests to compare program-exposed respondents to historical controls (2021 and 2022 respondents) and contemporary controls (2023 respondents without program exposure).

We received 545 responses from neurologists and critical care providers, including nurses, trainees, and attendings. Program-exposed respondents, relative to historical and contemporary controls respectively, reported greater usefulness of neuroprognostication (94% reporting often or always useful, versus 69% [p < 0.01]) and 68% [p < 0.01]), comprehensiveness of neuroprognostication (94% reporting often or always comprehensive, versus 76% [p = 0.02] and 66% [p < 0.01]), and greater satisfaction with neuroprognostication, particularly in comparison to the conventional model (63% reporting the program was “much better”).

Implementation of a specialized neuroprognostication program was associated with largely favorable attitudes towards neuroprognostication among providers. These findings encourage further study of this paradigm, and consideration of broader adoption to improve the practice of neuroprognostication.