Improving the fundamentals of care for older people in the acute hospital setting: facilitating practice improvement using a Knowledge Translation Toolkit

Abstract

This paper reports on a structured facilitation program where seven interdisciplinary teams conducted projects aimed at improving the care of the older person in the acute sector. Aims To develop and implement a structured intervention known as the Knowledge Translation (KT) Toolkit to improve the fundamentals of care for the older person in the acute care sector. Three hypotheses were tested: (i) frontline staff can be facilitated to use existing quality improvement tools and techniques and other resources (the KT Toolkit) in order to improve care of older people in the acute hospital setting; (ii) fundamental aspects of care for older people in the acute hospital setting can be improved through the introduction and use of specific evidence-based guidelines by frontline staff; and (iii) innovations can be introduced and improvements made to care within a 12-month cycle/timeframe with appropriate facilitation. Methods Using realistic evaluation methodology the impact of a structured facilitation program (the KT Toolkit) was assessed with the aim of providing a deeper understanding of how a range of tools, techniques and strategies may be used by clinicians to improve care. The intervention comprised three elements: the facilitation team recruited for specific knowledge, skills and expertise in KT, evidence-based practice and quality and safety; the facilitation, including a structured program of education, ongoing support and communication; and finally the components of the toolkit including elements already used within the study organisation. Results Small improvements in care were shown. The results for the individual projects varied from clarifying issues of concern and planning ongoing activities, to changing existing practices, to improving actual patient outcomes such as reducing functional decline. More importantly the study described how teams of clinicians can be facilitated using a structured program to conduct practice improvement activities with sufficient flexibility to meet the individual needs of the teams. Conclusions The range of tools in the KT Toolkit were found to be helpful, but not all tools needed to be used to achieve successful results. Facilitation of the teams was a central feature of the KT Toolkit and allowed clinicians to retain control of their projects; however, finding the balance between structuring the process and enabling teams to maintain ownership and control was an ongoing challenge. Clinicians may not have the requisite skills and experience in basic standard setting, audit and evaluation and it was therefore important to address this throughout the project. In time this builds capacity throughout the organisation. Identifying evidence to support practice is a challenge to clinicians. Evidence-based guidelines often lack specificity and were found to be difficult to assimilate easily into everyday practice. Evidence to inform practice needs to be provided in a variety of forms and formats that allow clinicians to easily identify the source of the evidence and then devel...

Using realist evaluation to open the black box of knowledge translation: a state-of-the-art review

“…2009 [41]UKEvaluationBirth CentreImplementation of care pathwayWiechula et al . 2009 [42]AustraliaEvaluationAcute care hospitalImplementation of Knowledge Translation ToolkitTolson et al . 2007 [43]UKEvaluationRural primary careImplementation of guidelines within a managed care network…”

“…2009 [41], Wiechula et al . 2009 [42], Tolson et al . 2007 [43]Participant or non-participant observationGoicolea et al .…”

“…2011 [32], Wiechula et al . 2009 [42]Quantitative measurement: assessment of defined construct or indicatorGoicolea et al . 2013 (presence vs. absence of behaviours, procedures, materials or information) [33], Chouinard et al .…”

Educating DNP Students about Critical Appraisal and Knowledge Translation

“…Step 2: knowledge translation A number of interventions have been suggested to reduce barriers and facilitate KT in clinical practice; mentorship (Melnyk et al, 2012;Newhouse, Dearholt, Poe, Pugh, & White, 2004), multi-disciplinary teams (Kitson et al, 2011;Wiechula et al, 2009), EBP rounds (FineoutOverholt et al, 2004), EBP committees (Mohide & Coker, 2005;Mohide & King, 2003), EBP workshops and journal clubs (Solomons & Spross, 2011), and EBP internships and partnering with PhD-level researchers (Vincent, Johnson, & Velasquez, 2010).…”

A Qualitative Evaluation of Web-Based Cancer Care Quality Improvement Toolkit Use in the Veterans Health Administration

“…Collaborative participation has been shown to have mixed effects on costs and QI outcomes. [7][8][9][10] Web-based QI toolkits are regarded as a less costly alternative or augmentation 11,12 to approaches such as collaboratives; however, there are few systematic evaluations of the effect of toolkits in the peer-reviewed literature. 13 For example, a recent evaluation of the AHRQ (Agency for Healthcare Research and Quality) Quality Indicators Toolkit for Hospitals revealed variable use of the tools, but these online toolkits may be a useful adjunct to existing QI processes.…”