The research agenda for protocol-based care

Rycroft‐Malone, Jo; Morrell, Clare; Bick, Debra

doi:10.7748/ns.19.6.33.s60

Cited by 14 publications

(12 citation statements)

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“…The construction of the framework was informed by the funder's requirement, an initial review of the literature undertaken for the proposal [6], and key policy developments. The study's theoretical framework integrates various components, including the four areas that play a role in protocol-based care and related impact on stakeholder outcomes: patients, staff, organisations, and policy makers:…”

Section: Resultsmentioning

confidence: 99%

“…However, in practice, practitioners are rarely bound to follow guidelines, protocols, and standards, and so 'rules' may not necessarily be a defining feature of protocol-based care per se . Because of this lack of clarity, we used protocol-based care as an umbrella term, which encompassed the use of a number of different care processes aimed at standardisation, including protocols, guidelines, care pathways, and algorithms that were being used in service delivery at the time of the study [6,7]. When we embarked on the study, it was unclear whether protocol-based care would be something greater than the sum of its parts [8].…”

Section: Introductionmentioning

confidence: 99%

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A realistic evaluation: the case of protocol-based care

et al. 2010

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Background'Protocol based care' was envisioned by policy makers as a mechanism for delivering on the service improvement agenda in England. Realistic evaluation is an increasingly popular approach, but few published examples exist, particularly in implementation research. To fill this gap, within this paper we describe the application of a realistic evaluation approach to the study of protocol-based care, whilst sharing findings of relevance about standardising care through the use of protocols, guidelines, and pathways.MethodsSituated between positivism and relativism, realistic evaluation is concerned with the identification of underlying causal mechanisms, how they work, and under what conditions. Fundamentally it focuses attention on finding out what works, for whom, how, and in what circumstances.ResultsIn this research, we were interested in understanding the relationships between the type and nature of particular approaches to protocol-based care (mechanisms), within different clinical settings (context), and what impacts this resulted in (outcomes). An evidence review using the principles of realist synthesis resulted in a number of propositions, i.e., context, mechanism, and outcome threads (CMOs). These propositions were then 'tested' through multiple case studies, using multiple methods including non-participant observation, interviews, and document analysis through an iterative analysis process. The initial propositions (conjectured CMOs) only partially corresponded to the findings that emerged during analysis. From the iterative analysis process of scrutinising mechanisms, context, and outcomes we were able to draw out some theoretically generalisable features about what works, for whom, how, and what circumstances in relation to the use of standardised care approaches (refined CMOs).ConclusionsAs one of the first studies to apply realistic evaluation in implementation research, it was a good fit, particularly given the growing emphasis on understanding how context influences evidence-based practice. The strengths and limitations of the approach are considered, including how to operationalise it and some of the challenges. This approach provided a useful interpretive framework with which to make sense of the multiple factors that were simultaneously at play and being observed through various data sources, and for developing explanatory theory about using standardised care approaches in practice.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A realistic evaluation: the case of protocol-based care

et al. 2010

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“…Healthcare professionals are obliged to work according to evidence‐based practice, which implies basing clinical decisions on integrated knowledge from the best available science, clinical experience, contextual circumstances and patients' requirements . This can be challenging in clinical contexts where complex problems involve series of related actions and decisions . Due to advances in understanding pathophysiology, innovations in supportive technology and an aging population, the field of intensive care is expanding in all western countries at a high cost .…”

Section: Introductionmentioning

confidence: 99%

“…In this context, protocol‐based care can provide a useful support to healthcare professionals, facilitate evidence‐based practice, improve patient care, reduce time with mechanical ventilation, decrease length of stay and imply cost savings . However, because the development and use of care protocols differ between settings and countries, there is a need for international knowledge sharing with regard to development, implementation and evaluation of the phenomenon .…”

Section: Introductionmentioning

confidence: 99%

Prevalence and quality of clinical pathways in Swedish intensive care units: a national survey

Bjurling-Sjöberg

Jansson

Wadensten

et al. 2013

Evaluation Clinical Practice

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SUMMARY AimsTo identify the prevalence of Clinical Pathways (CPs) in Swedish Intensive Care Units (ICUs) and to explore the quality, content and evidence base of the documents in use.Methods A descriptive and explorative survey of all Swedish ICUs (N84) and a review of submitted examples of CPs (n12) were conducted.Results CPs were in use at 20% of the Swedish ICUs. There was a significant geographic variation but no relationships between the use of CPs and category of hospital, type of ICU, size of ICU or type of health record applied. In total, 56 CPs were reported, within a range of scopes and extensions. The content of the ICUs' CPs as well as the degree to which they were interprofessional, evidence based and renewed varied.

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“…Studies have shown that hospital staff believe SCPs increase their ability to provide high-quality patient care (Lee 2005, 2006, Dahm & Wadensten 2008, P€ oder et al 2011, Svensson et al 2012, Bjurling-Sj€ oberg et al 2013, Jakobsson & Wann-Hansson 2013. SCPs may also help staff improve patient outcomes, reduce length of hospital stays, and enhance teamwork and record keeping (Rycroft-Malone et al 2004, Deneckere et al 2013, Deng et al 2014. Furthermore, a Cochrane review including 27 studies concluded that use of SCPs is associated with reduced hospital complications and improved documentation .…”

Section: Introductionmentioning

confidence: 99%