A Cluster Randomized Knowledge Transfer Trial in 4,457 Minor Head Injury Patients

Stiell, Ian G.; Clement, Clare; Grimshaw, J; Rowe, Brian H.; Schull, Michael J.; Lee, J.; Brehaut, Jamie; Letovsky, Eric; MacPhail, Iain; Shah, Abdullah; Ross, Sarah J.; McKnight, R. Douglas; Dreyer, Jonathan; Edmonds, M E; Rutledge, Thomas; Clarke, Ali; Perry, Jo; Wells, Greg D.; Group, Study

doi:10.1197/j.aem.2007.03.941

“…In EM, a form of reminders has been both successful (for cervical spine radiography ordering) 31 and unsuccessful (head computerized tomography ordering). 32 These reminders can be expensive when used manually, so alternatives such as computerized reminders are likely needed for sustainability.…”

Section: Would Eps Accept Academic Detailing As a Methods Ofmentioning

confidence: 99%

Effective Synthesized/preappraised Evidence Formats in Emergency Medicine and the Use of Supplemental Knowledge Translation Techniques

Rowe¹,

Diner²,

Camargo³

et al. 2007

Academic Emergency Medicine

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Most clinicians, and especially emergency physicians, are increasingly faced with the need for valid and reliable evidence upon which to base practice decisions in a timely fashion. Despite the accumulation of synthesized evidence in emergency medicine over the past decade, knowledge gaps still exist between what is known and what is practiced. In many cases, this failure in knowledge uptake relates to barriers in uptake as well as the difficulty of translating evidence from research to the bedside. Preappraised evidence syntheses represent a potential partial solution to these problems by providing condensed summaries of the large volume of scientific literature in our field. The participants in this workshop examined the availability, utility, and impact of preappraised evidence and examined innovative ways to translate this knowledge into practice. In addition, the workshop participants also explored more globally all knowledge translation methods that are distinct from clinical pathways (e.g., audit and feedback, academic detailing, reminders, and local opinion leaders). These are initiatives that are instituted at the level of a particular hospital or with respect to a certain condition, and emergency physicians need to understand their definition and application. Overall, the recommendations arising from this workshop have the potential to alter future emergency care in important ways.

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“…27 The Canadian CT Head Rule was derived (N = 3,121) 28 and validated (N = 2,707) 29 before a multicenter implementation trial 30 ( Table 4). The recently completed implementation trial (2004)(2005)(2006)) used a matched-pair cluster randomized design and also compared 12-month before and after periods at 12 EDs.…”

Section: The Canadian Ct Head Rulementioning

confidence: 99%

Implementation of Clinical Decision Rules in the Emergency Department

Stiell

¹

,

Bennett²

2007

Academic Emergency Medicine

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Clinical decision rules (CDRs) are tools designed to help clinicians make bedside diagnostic and therapeutic decisions. The development of a CDR involves three stages: derivation, validation, and implementation. Several criteria need to be considered when designing and evaluating the results of an implementation trial. In this article, the authors review the results of implementation studies evaluating the effect of four CDRs: the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule, and the Canadian CT Head Rule. Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries. However, a recent trial failed to demonstrate an impact on computed tomography imaging rates. Well-developed and validated CDRs can be successfully implemented into practice, efficiently standardizing ED care. However, further research is needed to identify barriers to implementation in order to achieve improved uptake in the ED.ACADEMIC EMERGENCY MEDICINE 2007; 14:955-959 ª

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Implementation of Clinical Decision Rules in the Emergency Department

Stiell¹,

Bennett²

2007

Academic Emergency Medicine

View full text Add to dashboard Cite

Clinical decision rules (CDRs) are tools designed to help clinicians make bedside diagnostic and therapeutic decisions. The development of a CDR involves three stages: derivation, validation, and implementation. Several criteria need to be considered when designing and evaluating the results of an implementation trial. In this article, the authors review the results of implementation studies evaluating the effect of four CDRs: the Ottawa Ankle Rules, the Ottawa Knee Rule, the Canadian C-Spine Rule, and the Canadian CT Head Rule. Four implementation studies demonstrated that the implementation of CDRs in the emergency department (ED) safely reduced the use of radiography for ankle, knee, and cervical spine injuries. However, a recent trial failed to demonstrate an impact on computed tomography imaging rates. Well-developed and validated CDRs can be successfully implemented into practice, efficiently standardizing ED care. However, further research is needed to identify barriers to implementation in order to achieve improved uptake in the ED.

show abstract

A Cluster Randomized Knowledge Transfer Trial in 4,457 Minor Head Injury Patients

Cited by 4 publications

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Effective Synthesized/preappraised Evidence Formats in Emergency Medicine and the Use of Supplemental Knowledge Translation Techniques

Effective Synthesized/preappraised Evidence Formats in Emergency Medicine and the Use of Supplemental Knowledge Translation Techniques

Implementation of Clinical Decision Rules in the Emergency Department

Implementation of Clinical Decision Rules in the Emergency Department

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