Strategies Addressing Barriers to the Implementation of a Pediatric Hand Fracture Care Pathway

Area of Science:

• Pediatric Orthopedics
• Healthcare Implementation Science
• Clinical Pathway Development

Background:

• Pediatric hand fractures often have suboptimal care pathways.
• The Calgary Kids' Hand Rule (CKHR) was developed to identify fractures needing specialist referral.
• A new care pathway based on CKHR requires implementation strategies.

Purpose of the Study:

• Identify barriers and facilitators to implementing a CKHR-based pediatric hand fracture care pathway.
• Generate tailored strategies to support the pathway's implementation.
• Improve care for pediatric hand fractures.

Main Methods:

• Conventional content analysis of focus group transcripts from parents, physicians, surgeons, and therapists.
• Mapping identified concepts (barriers and facilitators) to implementation frameworks.
• Stakeholder discussions to refine implementation strategies.

Main Results:

• Facilitators included established rapport, streamlined care potential, and perceived therapist expertise.
• Barriers comprised concerns about outcomes, trust, awareness, referral processes, and resources.
• Proposed strategies include pilot testing, communication, knowledge translation, system integration, and patient education materials.

Conclusions:

• Implementation frameworks informed tailored strategies for a new pediatric hand fracture pathway.
• Addressing identified barriers is crucial for successful pathway implementation.
• This study advances the adoption of evidence-based care for pediatric hand fractures.