Optimising implementation of a patient‐assessment framework for emergency nurses: A mixed‐method study

Munroe, Belinda; Curtis, Kate; Buckley, Thomas; Lewis, Melinda; Atkins, Lou

doi:10.1111/jocn.13932

Cited by 13 publications

(19 citation statements)

References 39 publications

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“…These findings are consistent with other studies showing that a lack of awareness of guidelines or perceived lack of evidence for measurable change represent a barrier to CP implementation [45,47,48]. Other researchers have highlighted the importance of developing educational material for clinical personnel [43], designing innovative strategies to optimize clinician education in high stress and fast-paced settings [41], and focusing on training and education as key intervention functions for enabling behaviour change [39,40].…”

Section: Knowledge Dissemination and Aligning Informationsupporting

confidence: 87%

“…While this study was not intended to systematically identify intervention functions or behaviour change techniques as some studies have done according to the Behaviour Change Wheel (BCW) framework [39][40][41][42], we found that by adopting the TDF as an analytical framework, we were able to successfully identify the facilitators and barriers that would impact the implementation of a CP for pediatric concussion in emergency departments. The 6 clusters of TDF domains identified in the interviews each reflect 2-4 predominant concerns that can be condensed into six overarching themes regarding clinicians' views on the implementation of a CP.…”

Section: Discussionmentioning

confidence: 99%

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“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

Zemek

Wright

et al. 2021

BMC Health Serv Res

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Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

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Section: Knowledge Dissemination and Aligning Informationsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

Zemek

Wright

et al. 2021

BMC Health Serv Res

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“…This paper illustrates the use of validated frameworks of behaviour change to identify facilitators and barriers and select implementation strategies for the implementation of a blunt chest injury care bundle . This paper adds to researcher experiences of the prospective use of the TDF and Behaviour Change Wheel as a theory-based implementation strategy in emergency care [7, 12, 32, 36–39]. This paper provides a worked example of the use of the TDF and Behaviour Change Wheel used together systematically to identify facilitators and barriers and derive implementation strategies.…”

Section: Discussionmentioning

confidence: 99%

Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study

Kourouche

Buckley

Van

et al. 2019

BMC Health Serv Res

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Background Blunt chest injury can lead to significant morbidity and mortality if not treated appropriately. A blunt chest injury care bundle was to be implemented at two sites to guide care. Aim To identify facilitators and barriers to the implementation of a blunt chest injury care bundle and design strategies tailored to promote future implementation. Methods 1) A mixed-method survey based on the theoretical domains framework (TDF) was used to identify barriers and facilitators to the implementation of a blunt chest injury care bundle. This survey was distributed to 441 staff from 12 departments across two hospitals. Quantitative data were analysed using SPSS and qualitative using inductive content analysis. 2) The quantitative and qualitative results from the survey were integrated and mapped to each of the TDF domains. 3) The facilitators and barriers were evaluated using the Behaviour Change Wheel to extract specific intervention functions, policies, behaviour change techniques and implementation strategies. Each phase was assessed against the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects or safety and Equity (APEASE) criteria. Results One hundred ninety eight staff completed the survey. All departments surveyed were represented. Nine facilitators and six barriers were identified from eight domains of the TDF. Facilitators ( TDF domains ) were: understanding evidence-informed patient care and understanding risk factors ( Knowledge ); patient assessment skills and blunt chest injury management skills ( Physical skills ); identification with professional role ( Professional role and identity ); belief of consequences of care bundle (Belief about consequences ); provision of training and protocol design ( Environmental context and resources ); and social supports ( Social influences ). Barriers were: not understanding the term ‘care bundle’ ( Knowledge ); lacking regional analgesia skills ( Physical skills ); not remembering to follow protocol ( Memory, attention, and decision processes ); negative emotions relating to new protocols ( Emotions ); equipment and protocol access ( Environmental context and resources ). Implementation strategies were videos, education sessions, visual prompt for electronic medical records and change champions. Conclusions Multiple facilitators and barriers were identified that may affect the implementation of a blunt chest injury care bundle. Implement...

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“…Implementation strategies need to support individual practitioners, managers, and understand the context as well as receive strong organisational support and patronage which is in uential to normalising a new practice among staff 23 . An evidence informed and context speci c implementation strategy is essential to sustained, reliable and high uptake 16,24 . While education and training is accompanied by associated cost, this study has shown that HIRAID can lead to signi cant cost bene ts and pay back for an organisation.…”

Section: Discussionmentioning

confidence: 99%

Implementation of A Structured Emergency Nursing Framework Results in Significant Cost Benefit

Curtis

Sivabalan

Bedford

et al. 2021

Preprint

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Background Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 hours. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework. Methods This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis. Results The HIRAID-equivalent savings exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022-23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022-23. Conclusions The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.

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Optimising implementation of a patient‐assessment framework for emergency nurses: A mixed‐method study

Cited by 13 publications

References 39 publications

“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study

Implementation of A Structured Emergency Nursing Framework Results in Significant Cost Benefit

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