"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.
Clinical pathway
Emergency care
Health outcomes
Implementation
Pediatric concussion
Standardization
Theoretical domains framework
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
05 Feb 2021
05 Feb 2021
Historique:
received:
14
06
2019
accepted:
21
01
2021
entrez:
6
2
2021
pubmed:
7
2
2021
medline:
15
5
2021
Statut:
epublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 33546684
doi: 10.1186/s12913-021-06110-2
pii: 10.1186/s12913-021-06110-2
pmc: PMC7863464
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
119Références
Implement Sci. 2012 Aug 28;7:77
pubmed: 22929925
Implement Sci. 2012 Sep 21;7:93
pubmed: 22999460
Cochrane Database Syst Rev. 2010 Mar 17;(3):CD006632
pubmed: 20238347
J Paediatr Child Health. 2016 Feb;52(2):151-7
pubmed: 26174579
Implement Sci. 2017 Jul 17;12(1):88
pubmed: 28716152
J Qual Clin Pract. 2001 Sep;21(3):50-5
pubmed: 11892822
Implement Sci. 2007 Mar 26;2:8
pubmed: 17386102
Pediatr Qual Saf. 2020 Mar 25;5(2):e270
pubmed: 32426636
Implement Sci. 2012 Apr 24;7:35
pubmed: 22531601
BMC Health Serv Res. 2013 Jan 31;13:36
pubmed: 23368720
JAMA Pediatr. 2016 Dec 5;170(12):e162900
pubmed: 27775762
Am J Manag Care. 2006 May;12(5):261-6
pubmed: 16686583
Arch Pediatr Adolesc Med. 2001 Sep;155(9):1057-62
pubmed: 11529809
BMC Health Serv Res. 2019 Jul 8;19(1):461
pubmed: 31286954
Med Educ. 2000 Dec;34(12):987-93
pubmed: 11123561
J Child Neurol. 2016 Jan;31(1):57-67
pubmed: 25330797
Pediatrics. 2009 Mar;123(3):735-43
pubmed: 19254996
Pediatr Clin North Am. 2009 Aug;56(4):893-904
pubmed: 19660633
Implement Sci. 2012 Aug 31;7:82
pubmed: 22938135
J Athl Train. 2013 Jul-Aug;48(4):554-75
pubmed: 23855364
Implement Sci. 2008 Feb 22;3:11
pubmed: 18294375
Implement Sci. 2010 Nov 10;5:86
pubmed: 21067614
Paediatr Child Health. 2014 Nov;19(9):475-80
pubmed: 25414583
Implement Sci. 2012 Sep 11;7:86
pubmed: 22967756
BMC Health Serv Res. 2009 May 25;9:83
pubmed: 19463196
Implement Sci. 2012 Aug 03;7:73
pubmed: 22862968
CJEM. 2015 Mar;17(2):115-22
pubmed: 25927255
JAMA Pediatr. 2019 Jan 1;173(1):e183820
pubmed: 30398522
Implement Sci. 2012 Apr 24;7:38
pubmed: 22531013
JAMA. 2016 Mar 8;315(10):1014-25
pubmed: 26954410
Pediatrics. 2010 Aug;126(2):e374-81
pubmed: 20660554
Qual Saf Health Care. 2005 Feb;14(1):26-33
pubmed: 15692000
J Asthma. 2018 Nov;55(11):1223-1236
pubmed: 29261346
Can Fam Physician. 2014 Jun;60(6):e310, e312-5
pubmed: 24925965
Implement Sci. 2019 Apr 29;14(1):43
pubmed: 31036023
Implement Sci. 2011 Apr 23;6:42
pubmed: 21513547
Br J Health Psychol. 2009 Nov;14(Pt 4):625-46
pubmed: 19159506
Implement Sci. 2012 Apr 24;7:37
pubmed: 22530986
Clin Pediatr (Phila). 2006 May;45(4):325-33
pubmed: 16703155
J Physiother. 2017 Apr;63(2):84-93
pubmed: 28433238
MMWR Morb Mortal Wkly Rep. 2011 Oct 7;60(39):1337-42
pubmed: 21976115
J Clin Nurs. 2018 Jan;27(1-2):e269-e286
pubmed: 28618040