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Tertiary Healthcare System

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Specialized care provided over an extended period is called tertiary care. Usually, a primary or secondary care physician will refer a patient to tertiary care. A patient's maximum physical and mental function is restored in tertiary care, which is caused due to the impact of a chronic illness or condition. Tertiary care aims to achieve the highest level of functioning possible while managing chronic illness. For example, a patient who falls and fractures their hip will need secondary care...
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Trends in nursing are multifactorial and associated with changes in society, within the nursing profession, and in other professions. Notably, telehealth and remote nursing contribute to successful healthcare delivery for numerous patients and help reduce stress for nurses due to nursing shortages. Nurses can reach patients, monitor their conditions, and interact with them using computers, audio, visual accessories, and telephones—for example, remote patient monitoring systems. Likewise,...
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Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
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Nursing Clinical Information System (NCIS)
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The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
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The SITS framework: sustaining innovations in tertiary settings.

Letitia Nadalin Penno1,2, Ian D Graham3,4, Chantal Backman2

  • 1Faculty of Environment and Health Sciences, Canadore College, North Bay, ON, Canada.

Frontiers in Health Services
|June 26, 2023
PubMed
Summary

This study introduces the Sustaining Innovations in Tertiary Settings (SITS) framework to guide the long-term use of evidence-based practices (EBPs) in hospitals. The SITS framework offers constructs, determinants, and interventions to ensure sustained EBP use and improve patient outcomes.

Keywords:
adherenceevidence-based practicesframeworks/models/theoriesguidelinesinnovationsinterventionsnursingsustainability

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Area of Science:

  • Healthcare Management
  • Knowledge Translation
  • Clinical Practice Improvement

Background:

  • Limited research exists on sustaining evidence-based practices (EBPs) beyond two years in tertiary care settings.
  • Existing implementation frameworks often lack detail for the long-term sustainment phase of EBPs.
  • Understanding determinants for sustained EBP use in hospitals is crucial for improving patient care.

Purpose of the Study:

  • To present an evidence-informed framework for sustaining EBPs in tertiary settings.
  • To incorporate constructs, determinants, and knowledge translation interventions (KTIs) for ongoing EBP use.
  • To guide practitioners and researchers in the long-term implementation of EBPs.

Main Methods:

  • Combined a systematic review of sustainability frameworks with a mixed-methods case study.
  • Analyzed data from 8 sustainability frameworks, interviews with nurses (n=19), chart audits (n=200), and document reviews (n=29).
  • Examined the sustained use of an organization-wide pain EBP in a Canadian tertiary care center.

Main Results:

  • Introduced the Sustaining Innovations in Tertiary Settings (SITS) framework with 7 constructs, 49 determinants, and 29 KTIs.
  • Identified 3 determinants and 8 KTIs with continuous influence during implementation and sustainment.
  • Highlighted the need to consider the level of application, changing conditions, and participatory approaches for sustainment.

Conclusions:

  • The SITS framework is a novel resource for sustaining EBPs in tertiary settings and enhancing patient outcomes.
  • Sustainability of EBPs is a dynamic and ongoing process, not a static endpoint.
  • The framework supports future research and practice aimed at long-term EBP integration.