Sabina B Gesell1, Shannon L Golden2, Alexander T Limkakeng3, Christine M Carr4, Andrew Matuskowitz5, Lane M Smith6, Simon A Mahler7. 1. From the Departments of Social Sciences and Health Policy and Implementation Science, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC. 2. Department of Social Sciences and Health Policy, and Qualitative and Patient-Reported Outcomes Developing Shared Resource, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC. 3. Division of Emergency Medicine, Duke University Medical Center, Durham, NC. 4. Department of Emergency Medicine and Public Health Sciences, Medical University of South Carolina, Charleston, SC. 5. Department of Emergency Medicine, Medical University of South Carolina. 6. Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC. 7. Departments of Emergency Medicine, Implementation Science, and Epidemiology and Prevention, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC.
Abstract
OBJECTIVE: The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Consolidated Framework for Implementation Research, we sought to identify important barriers and facilitators to implementation of the HEART Pathway. STUDY SETTING: Data were collected at 4 academic medical centers. STUDY DESIGN: We conducted semi-structured interviews with 25 key stakeholders (e.g., health system leaders, ED physicians). We conducted interviews before implementation of the HEART Pathway tool to identify potential barriers and facilitators to successful adoption at other regional academic medical centers. We also conducted postimplementation interviews at 1 medical center, to understand factors that contributed to successful adoption. DATA COLLECTION: Interviews were recorded and transcribed verbatim. We used a Consolidated Framework for Implementation Research framework-driven deductive approach for coding and analysis. PRINCIPAL FINDINGS: Potential barriers to implementation include time and resource burden, challenges specific to the electronic health record, sustained communication with and engagement of stakeholders, and patient concerns. Facilitators to implementation include strength of evidence for reduced length of stay and unnecessary testing and iatrogenic complications, ease of use, and supportive provider climate for evidence-based decision tools. CONCLUSIONS: Successful dissemination of the HEART Pathway will require addressing institution-specific barriers, which includes engaging clinical and financial stakeholders. New SMART-FHIR technologies, compatible with many electronic health record systems, can overcome barriers to health systems with limited information technology resources.
OBJECTIVE: The HEART Pathway is an evidence-based decision tool for identifying emergency department (ED) patients with acute chest pain who are candidates for early discharge, to reduce unhelpful and potentially harmful hospitalizations. Guided by the Consolidated Framework for Implementation Research, we sought to identify important barriers and facilitators to implementation of the HEART Pathway. STUDY SETTING: Data were collected at 4 academic medical centers. STUDY DESIGN: We conducted semi-structured interviews with 25 key stakeholders (e.g., health system leaders, ED physicians). We conducted interviews before implementation of the HEART Pathway tool to identify potential barriers and facilitators to successful adoption at other regional academic medical centers. We also conducted postimplementation interviews at 1 medical center, to understand factors that contributed to successful adoption. DATA COLLECTION: Interviews were recorded and transcribed verbatim. We used a Consolidated Framework for Implementation Research framework-driven deductive approach for coding and analysis. PRINCIPAL FINDINGS: Potential barriers to implementation include time and resource burden, challenges specific to the electronic health record, sustained communication with and engagement of stakeholders, and patient concerns. Facilitators to implementation include strength of evidence for reduced length of stay and unnecessary testing and iatrogenic complications, ease of use, and supportive provider climate for evidence-based decision tools. CONCLUSIONS: Successful dissemination of the HEART Pathway will require addressing institution-specific barriers, which includes engaging clinical and financial stakeholders. New SMART-FHIR technologies, compatible with many electronic health record systems, can overcome barriers to health systems with limited information technology resources.
Authors: Andrzej Budaj; David Brieger; Ph Gabriel Steg; Shaun G Goodman; Omar H Dabbous; Keith A A Fox; Alvaro Avezum; Christopher P Cannon; Tomasz Mazurek; Marcus D Flather; Frans Van De Werf Journal: Am Heart J Date: 2003-12 Impact factor: 4.749
Authors: Simon A Mahler; Chadwick D Miller; Judd E Hollander; John T Nagurney; Robert Birkhahn; Adam J Singer; Nathan I Shapiro; Ted Glynn; Richard Nowak; Basmah Safdar; Mary Peberdy; Francis L Counselman; Abhinav Chandra; Joshua Kosowsky; James Neuenschwander; Jon W Schrock; Stephen Plantholt; Deborah B Diercks; W Frank Peacock Journal: Int J Cardiol Date: 2012-10-30 Impact factor: 4.164
Authors: J H Pope; T P Aufderheide; R Ruthazer; R H Woolard; J A Feldman; J R Beshansky; J L Griffith; H P Selker Journal: N Engl J Med Date: 2000-04-20 Impact factor: 91.245
Authors: David H Newman; Brian Ackerman; Matthew L Kraushar; Margo H Lederhandler; Amal Masri; Anna Starikov; Daisy T Tsao; H Pendell Meyers; Kaushal H Shah Journal: Ann Emerg Med Date: 2015-03-04 Impact factor: 5.721
Authors: Steven M Asch; David W Baker; Joan W Keesey; Michael Broder; Matthias Schonlau; Mayde Rosen; Peggy L Wallace; Emmett B Keeler Journal: Med Care Date: 2005-07 Impact factor: 2.983
Authors: Laura J Damschroder; David C Aron; Rosalind E Keith; Susan R Kirsh; Jeffery A Alexander; Julie C Lowery Journal: Implement Sci Date: 2009-08-07 Impact factor: 7.327
Authors: Lauren T Southerland; Julie A Stephens; Christopher R Carpenter; Lorraine C Mion; Susan D Moffatt-Bruce; Angela Zachman; Michael Hill; Jeffrey M Caterino Journal: Implement Sci Commun Date: 2020-02-25
Authors: Lauren T Southerland; Katherine M Hunold; Jenifer Van Fossen; Jeffrey M Caterino; Peg Gulker; Julie A Stephens; Jason J Bischof; Erin Farrell; Christopher R Carpenter; Lorraine C Mion Journal: J Am Geriatr Soc Date: 2021-09-27 Impact factor: 5.562
Authors: Jasmeet S Dhaliwal; Foster Goss; Melanie D Whittington; Kelly Bookman; P Michael Ho; Richard Zane; Jennifer Wiler Journal: J Am Coll Emerg Physicians Open Date: 2020-11-17
Authors: Andrew J Matuskowitz; Jihad S Obeid; Lindsey Jennings; Richard R Bayer; Viswanathan Ramakrishnan; U Joseph Schoepf; Edward C Jauch Journal: Crit Pathw Cardiol Date: 2021-12-01
Authors: Angelo Navas; Billy Guzman; Almujtaba Hassan; Joseph B Borawski; Dean Harrison; Pratik Manandhar; Alaatin Erkanli; Alexander T Limkakeng Journal: West J Emerg Med Date: 2022-01-18
Authors: Geoffrey D Barnes; Emily Sippola; Allison Ranusch; Linda Takamine; Michael Lanham; Michael Dorsch; Anne Sales; Jeremy Sussman Journal: Implement Sci Commun Date: 2022-02-02