Anh Ly1, Roger Zemek2, Bruce Wright3, Jennifer Zwicker4, Kathryn Schneider5, Angelo Mikrogianakis6, Alf Conradi7, David Johnson8, Brenda Clark9, Karen Barlow10, Joseph Burey11, Ash Kolstad5, Keith Owen Yeates12. 1. Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada. lya@ucalgary.ca. 2. Department of Pediatrics, University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada. 3. Department of Pediatrics, University of Alberta, 3-513 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 2R7, Canada. 4. University of Calgary, School of Public Policy, 906 8th Avenue SW, Calgary, Alberta, T2P 1H9, Canada. 5. University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada. 6. Department of Pediatrics, McMaster University, 1280 Main Street, Hamilton, Ontario, L8S 4K1, Canada. 7. Department of Pediatrics, University of Alberta, 4-539 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 2R7, Canada. 8. Department of Pediatrics, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8, Canada. 9. Department of Pediatrics, University of Alberta, 10230 111 Avenue, Edmonton, Alberta, T5G 0B7, Canada. 10. University of Queensland, Child Health Research Centre, Brisbane, QLD, 4072, Australia. 11. Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada. 12. Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
Abstract
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.
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.
Authors: Louise E Craig; Natalie Taylor; Rohan Grimley; Dominique A Cadilhac; Elizabeth McInnes; Rosemary Phillips; Simeon Dale; Denise O'Connor; Chris Levi; Mark Fitzgerald; Julie Considine; Jeremy M Grimshaw; Richard Gerraty; N Wah Cheung; Jeanette Ward; Sandy Middleton Journal: Implement Sci Date: 2017-07-17 Impact factor: 7.327
Authors: Rafat Islam; Alan T Tinmouth; Jill J Francis; Jamie C Brehaut; Jennifer Born; Charlotte Stockton; Simon J Stanworth; Martin P Eccles; Brian H Cuthbertson; Chris Hyde; Jeremy M Grimshaw Journal: Implement Sci Date: 2012-09-21 Impact factor: 7.327
Authors: Susan Michie; Stephen Pilling; Philippa Garety; Paula Whitty; Martin P Eccles; Marie Johnston; Jemma Simmons Journal: Implement Sci Date: 2007-03-26 Impact factor: 7.327