Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

Implementation Science

David W Johnson⁷  Jeremy Grimshaw^1,13  Monica Taljaard⁴  Terry Klassen^1,14  Alison Paprica⁵  Mark Shafir⁸  Amanda Newton^1,15  M Louise McNaughton-Filion⁶  M Diane Lougheed^1,10  Francine M Ducharme^1,12  Thomas Rotter¹  Astrid Guttman²  Shannon D Scott^1,11  Janet Curran³  Mona Jabbour⁹ 

[1] College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada;Department of Paediatrics and Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada;IWK Health Centre, Halifax, Canada, School of Nursing, Dalhousie University, Halifax, Canada;Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada;Ontario Ministry of Health and Long-Term Care, Toronto, Canada;Champlain Local Health Integrated Network, Ottawa, Canada;Department of Pediatrics, Physiology and Pharmacology, University of Calgary, Calgary, Canada;Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada;Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada;ICES-Queen’s University, Kingston, Canada;University of Alberta, Edmonton, Canada;Research Centre, CHU Sainte-Justine, Montreal, Canada;Department of Medicine, University of Ottawa, Ottawa, Canada;Manitoba Institute of Child Health, Winnipeg, Canada;Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada

关键词: Clinical outcomes;    Process outcomes;    Theory-based strategy;    Pediatric emergency care;    Intervention strategy;    Key interventions;    Clinical pathways;   

Others  :  813637
DOI  :  10.1186/1748-5908-8-55

 received in 2013-04-03, accepted in 2013-05-15,  发布年份 2013

【 摘 要 】

Background

The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways.

Design/methods

We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits.

Discussion

This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways.

Trial registration

ClinicalTrials.gov:NCT01815710

【 授权许可】

   
2013 Jabbour et al.; licensee BioMed Central Ltd.

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