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Contextual Factors Affecting Implementation of In-hospital Pediatric CPR Quality Improvement Interventions in a
Maya Dewan1,2,3, Allison Parsons2, Ken Tegtmeyer1,2
1Department of Pediatrics, University of Cincinnati College of Medicine; Cincinnati, Ohio.
Insights
Pediatric quality improvement (QI) collaboratives can improve resuscitation care. Stronger QI teams were associated with better implementation of QI interventions in pediatric cardiac arrest care.
Area of Science:
- Pediatric Resuscitation Quality (pediRES-Q) Collaborative
- Quality Improvement (QI) Interventions
- In-hospital Cardiac Arrest
Background:
- Pediatric quality improvement (QI) collaboratives are networks for cooperative learning across multiple sites.
- Identifying facilitators and barriers to implementing QI resuscitation interventions is crucial for multicenter collaboratives.
Purpose of the Study:
- To identify contextual facilitators and barriers to implementing QI resuscitation interventions within a multicenter resuscitation collaborative.
- To evaluate the association between the strength of local QI teams and the success of QI intervention implementation.
Main Methods:
- Mixed-methods evaluation using the Model for Understanding Success in Quality (MUSIQ) questionnaire and semistructured interviews.
- Administered MUSIQ to 13 US sites in the Pediatric Resuscitation Quality (pediRES-Q) Collaborative.
- Conducted interviews with site primary investigators adapted from the Consolidated Framework for Implementation Research.
Main Results:
- All 13 sites completed the MUSIQ; scores varied (median 118.7).
- Higher MUSIQ scores for QI team subsection correlated with higher implementation success (P=0.02).
- Facilitators included unified approach, fail-forward climate, leadership support, strong microculture, and knowledge sharing. Barriers included low team tenure, lack of resources, insufficient QI training, and limited buy-in.
Conclusions:
- A strong local QI team is associated with successful implementation of QI interventions.
- Understanding contextual factors is key to optimizing QI collaborative efforts in pediatric resuscitation.
Introduction:
Pediatric quality improvement (QI) collaboratives are multisite clinical networks that support cooperative learning. Our goal is to identify the contextual facilitators and barriers to implementing QI resuscitation interventions within a multicenter resuscitation collaborative.
Methods:
A mixed-methods evaluation of the contextual facilitators and barriers to implementation of a resuscitation QI bundle. We administered a quantitative questionnaire, the Model for Understanding Success in Quality (MUSIQ), to the Pediatric Resuscitation Quality (pediRES-Q) Collaborative. Its primary goal is to optimize the care of children who experience in-hospital cardiac arrest through a resuscitation QI bundle. We also conducted semistructured phone interviews with site primary investigators adapted from the Consolidated Framework for Implementation Research qualitative interview guide.
Results:
All 13 actively participating US sites completed the MUSIQ questionnaire. Total MUSIQ scores ranged from 86.0 to 140.5 (median of 118.7, interquartile range 103.6-124.5). Evaluation of the QI team subsection noted a mean score of 5.5 for low implementers and 6.1 for high implementers (P = 0.02). We conducted 8 interviews with the local QI team leadership. Contextual facilitators included a unified institutional approach to QI, a fail forward climate, leadership support, strong microculture, knowledge of other organizations, and prioritization of goals. Contextual barriers included low team tenure, no specific allocation of resources, lack of formalized QI training, and lack of support and buy-in by leaders and staff.
Conclusions:
Using mixed methods, we identified an association between the local QI team's strength and the successful implementation of the QI interventions.
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