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Implementation strategies in emergency management of children: A scoping review
Alex Aregbesola1,2, Ahmed M Abou-Setta3,4, George N Okoli3
1The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Implementing evidence-based practices in pediatric emergency care is crucial. Capacity building and scale-up strategies show the most promise for improving care, though more high-quality research is needed.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Implementation Science
- Evidence-Based Practice Adoption
Background:
- Effective implementation strategies are essential for translating evidence into improved health outcomes and healthcare delivery, particularly in pediatric emergency settings.
- Children have unique physiological needs in medical or mental emergencies, necessitating tailored evidence-informed practice changes in emergency departments (EDs).
- Understanding the characteristics of implementation strategies is key to optimizing the emergency management of children.
Purpose of the Study:
- To identify and map the characteristics of implementation strategies used in the emergency management of children.
- To analyze the types and effectiveness of various implementation strategies in pediatric emergency care.
- To inform future research and practice regarding evidence uptake in pediatric emergency medicine.
Main Methods:
- A scoping review was conducted using Arksey and O'Malley's framework.
- Searched four major databases (Medline, Embase, Cochrane Central, CINAHL) from inception to May 2019 for relevant studies.
- Included 87 studies focusing on implementation strategies for children (≤21 years) in emergency settings, with descriptive analysis of extracted data.
Main Results:
- Most included studies (61%) used a before-and-after design, with a majority (70%) conducted in North America.
- Dissemination strategies were most common (89%), followed by process (54%) and integration (56%) strategies.
- Capacity building and scale-up strategies, though less common (15%), demonstrated the highest effectiveness (100%).
Conclusions:
- Implementation strategies in pediatric emergency care predominantly rely on non-randomized study designs.
- 'Dissemination' is the most frequently used strategy, while 'capacity building and scale-up' appear most effective.
- There is a need for higher-quality evidence, particularly from randomized-controlled trials, to rigorously assess the effectiveness of implementation strategies in this field.
Background:
Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children.
Methods:
We conducted a scoping review using Arksey and O'Malley's framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies.
Results:
We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%).
Conclusions:
Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that 'dissemination' is the most common strategy used, and 'capacity building and scale-up' are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.
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