A qualitative evidence synthesis (QES) exploring the barriers and facilitators to screening in emergency departments using the theoretical domains framework

Abstract

Background Validated screening tools can be utilised to detect early disease processes and risk factors for disease and adverse outcomes. Consequently, identifying individuals in need of early intervention and targeted assessment can be achieved through the implementation of screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review will assist in the identification of barriers and facilitators to screening in the ED using a QES to underpin implementation processes. Healthcare workers engage in screening in the ED routinely. Consequently, this review focused on synthesizing the experience of healthcare workers (HCWs) who are involved in this process. This synthesis is informed by a QES protocol published by the lead author in 2021 (Barry et al., HRB Open Res 3:50, 2021). Methodology A comprehensive literature search, inclusive of grey literature sources, was undertaken. Initially, an a priori framework of themes was formed to facilitate the interpretation and organisation of search results. A context specific conceptual model was then formulated using “Best fit” framework synthesis which further assisted in the interpretation of data that was extracted from relevant studies. Dual blind screening of search results was undertaken using RAYYAN as a platform. Thirty studies were identified that met the inclusion criteria. Dual appraisal of full text articles was undertaken using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively. Findings This is the first known synthesis of qualitative research on HCW’s experiences of screening in the ED. Predominantly, the findings illustrate that staff experience screening in the ED as a complex challenging process. The barriers and facilitators identified can be broadly categorised under preconditions to screen, motivations to screen and knowledge and skills to screen. Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were clear facilitators. Trial registration PROSPERO: CRD42020188712 05/07/20.

Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy

“…According to our data, no screening tool for identification of high-risk older patients is used in 41.6% of the cases, in line with previous literature [ 24 ]. In a recent qualitative evidence synthesis on screening in ED, findings illustrated that staff experiences screening in the ED as a challenging process and that competing interests, environmental stressors such as overcrowding and an organizational culture that resists screening were barriers [ 47 ]. Accumulating evidence indicates that implementing screening procedures in the ED enhances the effectiveness of geriatric interventions, helps in allocation of beds for hospitalized patients and directs the most vulnerable individuals toward geriatric evaluation and management units [ 13 , 48 ].…”

Healthcare workers experience of screening older adults in emergency care settings: A qualitative descriptive study using the Theoretical Domains Framework

“…NVivo 12 facilitated data management where each transcript was uploaded and quotes deductively mapped on to TDF constructs within each domain. Similar to the process outlined by Fitzgerald et al (2023), the de nition and narrative description of each theme, aligned with the study's overall aim guided the nal selection of relevant data excerpts (LB and RG). Barriers and facilitators to older person-centred screening were identi ed under each theme supported by illustrative quotes to emphasise key study ndings.…”

“…Emergency departments and acute assessment units (AAUs) (Emergency Care Settings) serve as critical access points to vital healthcare services for many patients (Hurley et al, 2019;Weber et al, 2023). Screening for disease or risk factors within these settings can identify individuals requiring specialist intervention, leading to enhancement in both individual and population health outcomes (Barry et al, 2023; Leahy et al, 2023, Weber et al, 2023. Implementation of screening tools for frailty, sepsis, falls, functional decline and healthcare utilisation in EDs underscores the growing emphasis on early disease identi cation and identi cation of associated risk factors (Kirk et al, 2016;Marcoux et al, 2018).…”

“…Ideally, a multidisciplinary assessment proforma should underpin the intervention plan enhancing the quality and consistency of documentation and promoting Comprehensive geriatric Assessment (CGA) initiation (Xu et al, 2021). Barry et al (2023) identi ed speci c barriers and facilitators to screening adults in emergency care settings (ED's, AAUs), forming the foundational synthesis for this study-the rst focused on screening in these environments. These ndings underscored the high motivation of HCWs to engage in screening when actively involved in implementation, provided with education, and supported to sustain practices in challenging settings.…”