Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation

Kourouche, Sarah; Curtis, Kate; Munroe, Belinda; Asha, Stephen Edward; Carey, Ian; Considine, Julie; Fry, Margaret; Lyons, Jack; Middleton, Sandy; Mitchell, Robert J.; Shaban, Ramon Z.; Unsworth, Annalise; Buckley, Thomas

doi:10.1016/j.aucc.2021.04.003

Cited by 7 publications

(7 citation statements)

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“… b % loss in VTM sensitivity = % sensitivity in SSTM − % sensitivity in VTM. c Z test for comparison of sensitivities between VTM versus SSTM using online tool https://epitools.ausvet.com.au/ztesttwo ( 26 , 27 ). d sensitivity % = [true positive/(true positive + false negative)] × 100.…”

Section: Resultsmentioning

confidence: 99%

“… c Z test for comparison of sensitivities between VTM versus SSTM using online tool https://epitools.ausvet.com.au/ztesttwo ( 26 , 27 ). …”

Section: Resultsmentioning

confidence: 99%

“…Differences in paired C t values for qPCR internal control and SARS-CoV-2 genes were scored using paired t test. Statistical comparison of patient diagnostic parameters and ROC curves was performed by 2-sample Z test using online tool https://epitools.ausvet.com.au/ztesttwo ( 27 , 28 ). In every statistical analysis, a P value of ≤0.05 was considered significant.…”

Section: Methodsmentioning

confidence: 99%

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A Cold Chain-Independent Specimen Collection and Transport Medium Improves Diagnostic Sensitivity and Minimizes Biosafety Challenges of COVID-19 Molecular Diagnosis

et al. 2021

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Approximately forty-four percent of the global population lives in villages, including 59% in Africa ( https://unhabitat.org/World%20Cities%20Report%202020 ). The fast-evolving nature of SARS-CoV-2 and its extremely contagious nature warrant early and accurate COVID-19 diagnostics across rural and urban population as a key to prevent viral transmission. Unfortunately, lack of adequate infrastructure, including the availability of biosafety-compliant facilities and an end-to-end cold chain availability for COVID-19 molecular diagnosis, limits the accessibility of testing in these countries.

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Section: Resultsmentioning

confidence: 99%

“… c Z test for comparison of sensitivities between VTM versus SSTM using online tool https://epitools.ausvet.com.au/ztesttwo ( 26 , 27 ). …”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A Cold Chain-Independent Specimen Collection and Transport Medium Improves Diagnostic Sensitivity and Minimizes Biosafety Challenges of COVID-19 Molecular Diagnosis

et al. 2021

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“…Examples of this variation include differences in pathways focusing on ICU escalation or admission criteria, [2][3][4][5] analgesia and pain assessment, [3][4][5][6][7] and respiratory care and assessment. [3][4][5][6] The heterogeneity of the intervention content and purpose has overall limited the ability to integrate findings and make inference. As identified in a previous review, this limitation was further demonstrated through the variation in patient outcomes used to evaluate the impact of these pathways.…”

Section: Commentsmentioning

confidence: 99%

What is the optimal care pathway for patients with blunt chest wall trauma presenting to the ED?

Baker

Battle

2023

Trauma

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Three-part question[In adults with blunt chest wall trauma presenting to the ED], what is the [optimal care pathway] for [days alive and out of hospital, quality of life at 6 months and patient reported experience]? Clinical scenarioA 54-year-old man attends your department having fallen off a two-step ladder on to a wooden chair. On their arrival the patient is complaining of right-sided chest pain. His vital signs are normal and there is no evidence of respiratory distress. On examination the patient is tender over rib 4, 5 and 6 on the right side but no further abnormality is identified but the patient has high levels of pain in the department despite receiving analgesics. There are many components to the patient's care that are required (e.g., analgesia, imaging, risk stratification, physiotherapy, ED discharge location) and these can be delivered using a formal care pathway. The optimal care pathway for managing patients with blunt chest trauma is yet to be determined. Search strategySearch strategies were developed by combining free-text and index term searching. A structured literature search was conducted (revised search: 25th May 2022) through the database Medline (Ovid) broadly following a previously published evidence review. 1 The following search strategy was used for all electronic databases with * denoting specific MeSH terms used in the review search strategy:

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“…This is in the manuscript preparation stage. The fidelity of delivery has been evaluated separately [19]. The treatments within the protocol are all evidence-based and reflect other existing pathways that have been demonstrated to be effective [20].…”

Section: Introductionmentioning

confidence: 99%

Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP)

Kourouche

Curtis

Munroe

et al. 2021

Implement Sci Commun

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Background Blunt chest wall injuries can lead to complications, especially without early intervention. A blunt Chest Injury Protocol (ChIP) was developed to help improve the consistency of evidence-based care following admission to the emergency department. Implementation strategy fidelity is the extent to which the strategies of implementation are delivered in line with the intended plan. The aim of this study was to assess fidelity to the strategies of the implementation plan developed for ChIP. Methods A retrospective evaluation of strategies used for implementation was performed, specifically the behaviour change techniques (BCTs). BCTs were used as part of an implementation plan derived based on the Behaviour Change Wheel from results from a staff survey at two hospitals. Levels of implementation or adaptation for BCTs were scored by implementers as follows: ‘Were the behaviour change interventions implemented?’ (0 = ‘not implemented’, 1 = partially implemented, and 2 = fully implemented); ‘Were adaptations made to the implementation plan?’, scored 1 (many changes from plan) to 4 (just as planned). Free text explanation to their responses was also collected with supporting evidence and documentation (such as emails, implementation checklists, audit reports, and incident reports). Results There was high overall fidelity of 97.6% for BCTs partially or fully implemented. More than three quarters (32/42, 76.2%) of the BCTs were fully implemented with an additional 9/42 (21.4%) partially implemented. BCTs that were not fully implemented were social support, feedback on behaviour, feedback on outcomes of behaviour, adding objects to the environment, and restructuring the environment. The modes of delivery with poorer implementation or increased adaptations were clinical champions and audit/feedback. Conclusions This study describes the evaluation of implementation strategy fidelity in the acute care context. The systematic use and application of the behaviour change wheel was used to develop an implementation plan and was associated with high implementation strategy fidelity. A fidelity checklist developed during the implementation process may help implementers assess fidelity. Trial registration Trial registered on ANZCTR. Registration number ACTRN12618001548224, date approved 17/09/2018

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Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation

Abstract: Please cite this article as: Kourouche S et al., Implementation of a hospital-wide multidisciplinary blunt chest injury care bundle (ChIP): Fidelity of delivery evaluation, Australian Critical Care,

Cited by 7 publications

References 51 publications

A Cold Chain-Independent Specimen Collection and Transport Medium Improves Diagnostic Sensitivity and Minimizes Biosafety Challenges of COVID-19 Molecular Diagnosis

A Cold Chain-Independent Specimen Collection and Transport Medium Improves Diagnostic Sensitivity and Minimizes Biosafety Challenges of COVID-19 Molecular Diagnosis

What is the optimal care pathway for patients with blunt chest wall trauma presenting to the ED?

Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP)

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