Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework.
Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework.
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DOI：
10.3390/medicina57060570
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发表时间：
2021-06-03
期刊：
影响因子：
--
通讯作者：
Williams MV
中科院分区：
文献类型：
--
作者：
Li J;Smyth SS;Clouser JM;McMullen CA;Gupta V;Williams MV
背景和目的：在晕厥的评估和管理中，过度使用和不适当使用检测和入院是常见的。尽管指南可用于优化晕厥护理，但研究表明，当前的临床指南并未显著影响急诊科（艾德）晕厥评估的资源利用。匹配的实施策略的障碍和促进者和定制策略，以当地的情况下，成功实施临床实践指南（CPG）的重大承诺。我们的团队应用实施科学原则来制定基于企业主的实施策略。方法和材料：我们与四个卫生系统的患者、家庭护理人员、一线临床医生和工作人员以及卫生系统管理人员合作，进行定量调查和定性访谈，以进行背景评估。执行战略的确定是通过应用CFIR-ERIC执行战略匹配工具和征求利益攸关方的意见来完成的。然后，我们与患者和一线团队共同设计，并开发和测试了具体的策略。结果：共有114名临床医生完成了调查，32名临床医生和利益相关者参加了访谈。调查和访谈的结果表明，对晕厥指南的认识较低，与患者的沟通困难，缺乏CPG方案整合到艾德工作流程中，以及组织流程变更是CPG实施的主要障碍。31名患者及其家庭护理人员参加了采访并表达了他们的期望：诊断的清晰度、护理计划和诊断测试的背景以及感到被关心的愿望。确定解决临床医生障碍的变更方法以及患者和家庭护理人员的期望，为多层次、多组分实施策略使命的开发提供信息，该策略包括患者教育材料、指导实施、学术细节、晕厥最佳护理途径和相应的移动的应用程序以及精益质量改进方法。使命的试点项目通过适当测试证明了可行性、可接受性和初步成功。结论：可以采用针对个人、团队和医疗保健系统的有效多方面实施策略来规划成功实施并促进对晕厥CPG的依从性。
Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, and developed and tested specific strategies. Results: A total of 114 clinicians completed surveys and 32 clinicians and stakeholders participated in interviews. Results from the surveys and interviews indicated low awareness of syncope guidelines, communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change as major barriers to CPG implementation. Thirty-one patients and their family caregivers participated in interviews and expressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. Identifying change methods to address the clinician barriers and patients and family caregivers expectations informed development of the multilevel, multicomponent implementation strategy, MISSION, which includes patient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and a corresponding mobile app, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Conclusions: Effective multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
24
作者：
Forman DE;Rich MW;Alexander KP;Zieman S;Maurer MS;Najjar SS;Cleveland JC Jr;Krumholz HM;Wenger NK
通讯作者：
Wenger NK
DOI：
10.1016/j.ajem.2020.05.029
发表时间：
2020-09
期刊：
The American journal of emergency medicine
影响因子：
--
作者：
Li J;Gupta V;Smyth SS;Cowley A;Du G;Sirrine M;Stearley S;Chadha R;Bhalla V;Williams MV
通讯作者：
Williams MV
影响因子：
3.6
作者：
Dipaola, Franca;Costantino, Giorgio;Furlan, Raffaello
通讯作者：
Furlan, Raffaello
影响因子：
1
作者：
Anderson, Jeffrey B.;Czosek, Richard J.;Marino, Bradley S.
通讯作者：
Marino, Bradley S.