Implementation of clinical practice changes in the PICU: a qualitative study using and refining the iPARIHS framework

Area of Science:

• Implementation Science
• Healthcare Management
• Pediatric Critical Care

Background:

• Evidence-based practice implementation often falls short in pediatric intensive care units (PICUs).
• Few studies have utilized implementation science frameworks to improve PICU practices.
• The integrated Promoting Action on Research Implementation in Health Services (iPARiHS) framework was employed to assess practice improvement in PICUs.

Purpose of the Study:

• To assess practice improvement in the PICU using the iPARIHS framework.
• To explore the utility of the iPARIHS framework for understanding PICU practice change.
• To identify barriers and facilitators to implementing evidence-based practices in PICUs.

Main Methods:

• The iPARIHS framework guided the development of semi-structured interviews with multi-professional providers.
• A qualitative analysis approach, based on iPARIHS constructs, was used to identify themes.
• Interviews were conducted with 50 providers across 8 U.S. PICUs.

Main Results:

• The PICU environment, including team complexity and high-stakes work, significantly shaped implementation phases.
• Provider willingness to adopt change was influenced by evidence, experience, beliefs, and workflow demands.
• iPARIHS constructs were useful, but inter-relations and a need for refined facilitation subconstructs were noted.

Conclusions:

• The PICU environment profoundly impacts practice change implementation.
• A process model for PICU implementation, shaped by the iPARIHS framework, may guide future efforts.
• While iPARIHS adequately identified barriers, further elaboration of facilitation subconstructs is needed for operationalization.