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P54– Barriers and facilitators for guideline use in emergency practice settings: A case study
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Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
P54– Barriers and facilitators for guideline use in emergency practice settings: A case study Janet A. Curran, PhD (Presenter) (Ottawa Hospital Research Institute, Ottawa, Ontario, Canada) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Barriers to implementation BACKGROUND (INTRODUCTION): Emergency practice settings pose unique challenges for understanding the use of best practice knowledge. Decisions are often made in a chaotic environment that is prone to multiple interruptions and distractions and where patient flow is a high priority. Knowledge tools such as clinical practice guidelines (CPGs) are present in these settings; however, variation in the use of guidelines continues to exist both within and between emergency departments (EDs). LEARNING OBJECTIVES (TRAINING GOALS): 1. Examine the use of case studies as a method to explore barriers and facilitators to guideline use. 2. Identify key factors influencing guideline use in emergency practice settings. METHODS: A case study method was used to explore characteristics of the individual clinician, the practice context, and the knowledge tool as factors relevant for the use of CPGs in rural and urban EDs. Case scenarios involving the use of CPGs were developed in consultation with the medical directors from four rural and urban EDs. Cases were further expanded through telephone interviews with a convenience sample of 12 physicians. Telephone interviews were guided by a structured interview tool containing 32 closed-ended items and three open-ended questions. Data were analyzed graphically and descriptively from a within-case and cross-case perspective. RESULTS: Case studies varied in acuity and volume of patients affected. Items related to professional networks (speaking with health professionals from other EDs and other physicians’ approval of practice), organizational structures (opportunity to provide input and continuing education activities), and relevance with patient outcomes (monitoring patient outcomes and improving patient outcomes) were related to the emergency physicians’ decision to use a clinical practice guideline. DISCUSSION (CONCLUSION): A number of barriers and facilitators were identified at the patient, health care provider, and context of practice levels. Understanding the factors that influence the use of knowledge tools in emergency practice settings will assist in the development of successful interventions for changing provider behavior and improving health outcomes. TARGET AUDIENCE(S): 1. Clinical researcher 2. Guideline developer 3. Guideline implementer 4. Allied health professionals 5. Nurses
P55– Does format of clinical guidelines influence acceptability/uptake by health care professionals? Elizabeth J. Shaw, MS (NICE, Manchester, England, United Kingdom); Judith Thornton, PhD (Presenter) (NICE, Manchester, England, United Kingdom); Kathryn Chamberlain (NICE, Manchester, England, United Kingdom); Lynda Ayiku (NICE, Manchester, England, United Kingdom) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Barriers to implementation BACKGROUND (INTRODUCTION): There are many factors that have been identified as affecting the implementation or uptake of clinical practice guidelines. However, the influences of different formats of guidelines on uptake by health care professionals have not been examined specifically. Anecdotal reports suggest that professionals find some guidelines overly long and difficult to navigate. LEARNING OBJECTIVES (TRAINING GOALS): 1. To understand whether the format of guidelines influences the acceptability/uptake of clinical guidelines in practice by health care professionals. 2. To explore which characteristics of guidelines are reported by health care professionals as affecting implementation. METHODS: Our first review, a systematic review of randomized controlled trials evaluating the effectiveness of changing the format or content of guidelines on health care professional behavior was undertaken. Usual systematic review methods were applied. In addition, a second exploratory, qualitative review of the characteristics of guidelines being reported as facilitating or proving barriers to implementation was also undertaken. Thematic analysis was used to synthesize the data from published articles (no study restriction was applied). RESULTS: This review is currently in development, but to date, no randomized controlled trials comparing different guideline formats or guidelines have been identified. Preliminary findings from the qualitative review suggest that the size, layout, and readability of the guideline are perceived as being barriers to implementation. However, very few details are reported, and there are very few examples of solutions to the perceived barriers being provided. DISCUSSION (CONCLUSION): Guideline developers should adhere to evidence-based guideline formats and content; however, there is very little evidence to determine the most appropriate format. Further work is needed to determine what characteristics of an evidence-based guideline are most important to users and whether this influences the uptake of recommendations. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Quality improvement manager/facilitator 5. Medical educator
Otolaryngology–Head and Neck Surgery, Vol 143, No 1S1, July 2010
P54– Barriers and facilitators for guideline use in emergency practice settings: A case study Janet A. Curran, PhD (Presenter) (Ottawa Hospital Research Institute, Ottawa, Ontario, Canada) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Barriers to implementation BACKGROUND (INTRODUCTION): Emergency practice settings pose unique challenges for understanding the use of best practice knowledge. Decisions are often made in a chaotic environment that is prone to multiple interruptions and distractions and where patient flow is a high priority. Knowledge tools such as clinical practice guidelines (CPGs) are present in these settings; however, variation in the use of guidelines continues to exist both within and between emergency departments (EDs). LEARNING OBJECTIVES (TRAINING GOALS): 1. Examine the use of case studies as a method to explore barriers and facilitators to guideline use. 2. Identify key factors influencing guideline use in emergency practice settings. METHODS: A case study method was used to explore characteristics of the individual clinician, the practice context, and the knowledge tool as factors relevant for the use of CPGs in rural and urban EDs. Case scenarios involving the use of CPGs were developed in consultation with the medical directors from four rural and urban EDs. Cases were further expanded through telephone interviews with a convenience sample of 12 physicians. Telephone interviews were guided by a structured interview tool containing 32 closed-ended items and three open-ended questions. Data were analyzed graphically and descriptively from a within-case and cross-case perspective. RESULTS: Case studies varied in acuity and volume of patients affected. Items related to professional networks (speaking with health professionals from other EDs and other physicians’ approval of practice), organizational structures (opportunity to provide input and continuing education activities), and relevance with patient outcomes (monitoring patient outcomes and improving patient outcomes) were related to the emergency physicians’ decision to use a clinical practice guideline. DISCUSSION (CONCLUSION): A number of barriers and facilitators were identified at the patient, health care provider, and context of practice levels. Understanding the factors that influence the use of knowledge tools in emergency practice settings will assist in the development of successful interventions for changing provider behavior and improving health outcomes. TARGET AUDIENCE(S): 1. Clinical researcher 2. Guideline developer 3. Guideline implementer 4. Allied health professionals 5. Nurses
P55– Does format of clinical guidelines influence acceptability/uptake by health care professionals? Elizabeth J. Shaw, MS (NICE, Manchester, England, United Kingdom); Judith Thornton, PhD (Presenter) (NICE, Manchester, England, United Kingdom); Kathryn Chamberlain (NICE, Manchester, England, United Kingdom); Lynda Ayiku (NICE, Manchester, England, United Kingdom) PRIMARY TRACK: Guideline implementation SECONDARY TRACK: Barriers to implementation BACKGROUND (INTRODUCTION): There are many factors that have been identified as affecting the implementation or uptake of clinical practice guidelines. However, the influences of different formats of guidelines on uptake by health care professionals have not been examined specifically. Anecdotal reports suggest that professionals find some guidelines overly long and difficult to navigate. LEARNING OBJECTIVES (TRAINING GOALS): 1. To understand whether the format of guidelines influences the acceptability/uptake of clinical guidelines in practice by health care professionals. 2. To explore which characteristics of guidelines are reported by health care professionals as affecting implementation. METHODS: Our first review, a systematic review of randomized controlled trials evaluating the effectiveness of changing the format or content of guidelines on health care professional behavior was undertaken. Usual systematic review methods were applied. In addition, a second exploratory, qualitative review of the characteristics of guidelines being reported as facilitating or proving barriers to implementation was also undertaken. Thematic analysis was used to synthesize the data from published articles (no study restriction was applied). RESULTS: This review is currently in development, but to date, no randomized controlled trials comparing different guideline formats or guidelines have been identified. Preliminary findings from the qualitative review suggest that the size, layout, and readability of the guideline are perceived as being barriers to implementation. However, very few details are reported, and there are very few examples of solutions to the perceived barriers being provided. DISCUSSION (CONCLUSION): Guideline developers should adhere to evidence-based guideline formats and content; however, there is very little evidence to determine the most appropriate format. Further work is needed to determine what characteristics of an evidence-based guideline are most important to users and whether this influences the uptake of recommendations. TARGET AUDIENCE(S): 1. Guideline developer 2. Guideline implementer 3. Developer of guideline-based products 4. Quality improvement manager/facilitator 5. Medical educator