None listed
Conditions
Brief summary
By embedding implementation science principles, IMPACT will enable the incorporation of clinical pathways into contemporary, patient-centred models of care across Tasmanian emergency departments (EDs) and the broader health sector, thereby improving the quality, efficiency and experience of acute care. The project will engage with all relevant stakeholders (consumers, ED clinicians, other community- and hospital-based health professionals, and policy makers). The experience in Tasmania will inform the development of a national acute care implementation science laboratory. We will reduce variation in care, improve service delivery, outcomes and efficiency of acute care, reduce pressure on EDs, and generate new knowledge applicable to assisting Australians living in rural and regional communities, when they are at their most vulnerable.
Interventions
In partnership with the health sector in each Tasmanian ED, we will identify, and explore the factors influencing practice variation for clinical pathways used in these EDs and develop targeted implementation strategies as part of an Implementation and Evaluation Toolkit (IET). An established, proven theory informed, co-designed approach to developing the strategies will be used. Using the Theoretical Domains Framework (TDF), qualitative interviews or focus groups will explore individual and org
In partnership with the health sector in each Tasmanian ED, we will identify, and explore the factors influencing practice variation for clinical pathways used in these EDs and develop targeted implementation strategies as part of an Implementation and Evaluation Toolkit (IET). An established, proven theory informed, co-designed approach to developing the strategies will be used. Using the Theoretical Domains Framework (TDF), qualitative interviews or focus groups will explore individual and organisational factors that contribute to variations in practice at each location. The TDF incorporates a range of behaviour change theories for use in implementation research. The validated TDF has demonstrated strong explanatory and predictive powers across health care, including acute care settings, and is particularly useful when selecting interventions to improve practice. Implementation strategies will be co-designed with clinicians at each hospital, taking into consideration the likelihood of the strategies impacting the identified influencing factors (grouped by TDF domains), evidence of their effectiveness and their acceptability/feasibility in the hospital setting. Assessments of ex-ante cost-effectiveness will also be used to support decision-making. The intervention will be an implementation toolkit for 4 clinical pathways used in ED: 1) Chest Pain 2) Suspected Stroke 3) Fractured Neck of Femur and 4) Suspected Sepsis. The intervention will be co-designed with clinicians. The toolkit has therefore yet to be developed and may be different at each site. Broadly, the physical or informational materials used will include education activities by champions within the health service, changes to how and where clinical pathways are accessed as well as audit and feedback as part of service delivery. The intervention will be delivered by the research team in conjunction with health service staff. The mode of delivery will be multimodal - education, system changes to how pathways are accessed and technology changes to incorporate audit and feedback into routine care. The number of times that the intervention will be delivered will be determined following co design and understanding of health service workload and built in implementation strategies. We aim to implement the toolkit over a 6 month period prior to evaluation. the location of the intervention will be all four Tasmanian public EDs: North West Regional Hospital, Mersey Community Hospital, Launceston General Hospital and royal Hobart Hospital EDs.
Sponsors
University of Tasmania
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
the measure of outcomes will include 4 specific pathways: chest pain, suspected stroke, suspected sepsis and fractured neck of femur All patients within the study period who are eligible for one of these four pathways will be included in the study. eligibility includes: 1) Chest pain pathway: triage description including chest pain as a presenting complaint 2) Suspected stroke pathway: triage description including suspicion of stroke as an assessment 3) Fractured Neck of Femur: Diagnosis of fractured neck of femur for that ED episode 4) Suspected sepsis pathway: blood cultures ordered by treating clinician
Exclusion criteria
Patients who have been treated and transferred between study EDs
Outcome results
None listed