Standardized Screening and Assessment of Older Emergency Department Patients: A Survey of Implementation in Quebec

2007 ◽  
Vol 26 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Jane McCusker ◽  
Josée Verdon ◽  
Nathalie Veillette ◽  
Katherine Berg ◽  
Tina Emond ◽  
...  
Keyword(s):  
Emergency Department ◽  
Participation Rate ◽  
Cost Effective ◽  
Assessment Tools ◽  
Local Context ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
Barriers To Implementation ◽  
The Difference ◽  
Emergency Department Patients

ABSTRACTCost-effective methods have been developed to help busy emergency department (ED) staff cope with the growing number of older patients, including quick screening and assessment tools to identify those at high risk and note their specific needs. This survey, from a sample of key informants from all EDs (n=111) in the province of Quebec (participation rate of 88.2%), investigated the implementation of these tools and barriers to implementation. Questionnaires (administered either by telephone or by self-completion) included characteristics of the ED, characteristics of the respondent, use of tools, and method of implementation. Barriers to the implementation of these tools included lack of resources for screening and follow-up, misunderstandings of the difference between screening and assessment tools, and need for adaptation of the tools to the local context. Education of staff and pre-implementation adaptation and testing are needed for successful implementation.

ISM-MICMAC approach for analysis of project-based learning barriers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Syed Khalid Perwez ◽  
Goutam Kumar Kundu
Keyword(s):  
Structural Model ◽  
Educational Institution ◽  
Project Based Learning ◽  
Educational Institutions ◽  
Successful Implementation ◽  
Implementation Barriers ◽  
Higher Educational Institutions ◽  
Content Type ◽  
Barriers To Implementation ◽  
Higher Educational

Purpose This paper aims to identify and model the key barriers to implementation of project-based learning (PjBL) in higher educational institution. Design/methodology/approach Using the interpretive structural modelling (ISM) technique, the study has developed a hierarchical-based model, depicting the mutual relationships amongst the key barriers to implementation of PjBL. Additionally, the paper has performed Matrice d’ Impacts Croises Multiplication Appliqué an Classement (MICMAC) analysis to categorize the barriers in terms of their driving and dependence power. Findings The study has identified the key barriers to implementation of PjBL and presented an integrated model using ISM. Higher educational institutions need to pay attention to diagnose and overcome these hindrances for effective implementation of PjBL in their programmes. Research limitations/implications The study adopts a systematic way to model the relevant barriers to implementation of PjBL. The ISM-based model would help higher education institutions to prioritize the issues as the barriers are hierarchically structured. As the input to model development is based on the experts’ opinions, it may be biased, influencing the final output of the structural model. Originality/value The presentation of PjBL implementation barriers in the form of an ISM-based model is a new effort. The model would be useful to understand the barriers and overcome these for the successful implementation of PjBL in higher educational institutions.

scholarly journals Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

2021 ◽  
Author(s):  
Jing Li ◽  
Susan S. Smyth ◽  
Jessica Miller Clouser ◽  
Colleen A. McMullen ◽  
Vedant Gupta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Family Caregivers ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Implementation Strategies ◽  
Mobile App ◽  
Care Plan ◽  
Local Context ◽  
Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

scholarly journals Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

Medicina ◽  
2021 ◽  
Vol 57 (6) ◽  
pp. 570
Author(s):  
Jing Li ◽  
Susan S. Smyth ◽  
Jessica M. Clouser ◽  
Colleen A. McMullen ◽  
Vedant Gupta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Family Caregivers ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Implementation Strategy ◽  
Implementation Strategies ◽  
Mobile App ◽  
Local Context ◽  
Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, research indicates that current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guidelines (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, and developed and tested specific strategies. Results: A total of 114 clinicians completed surveys and 32 clinicians and stakeholders participated in interviews. Results from the surveys and interviews indicated low awareness of syncope guidelines, communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change as major barriers to CPG implementation. Thirty-one patients and their family caregivers participated in interviews and expressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. Identifying change methods to address the clinician barriers and patients and family caregivers expectations informed development of the multilevel, multicomponent implementation strategy, MISSION, which includes patient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and a corresponding mobile app, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Conclusions: Effective multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

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