Sepsis screening protocol implementation: a clinician-validated rapid realist review.

Area of Science:

• Healthcare Quality Improvement
• Clinical Implementation Science
• Patient Safety Research

Background:

• Failed clinical practice implementation compromises patient safety and efficiency.
• Sepsis screening guideline implementation yields inconsistent results.
• A theoretical framework is needed to guide effective implementation strategies.

Purpose of the Study:

• To develop a programme theory for successful sepsis screening guideline implementation.
• To understand the mechanisms driving successful clinical intervention adoption.
• To provide a theory-based approach for enhancing healthcare quality and safety.

Main Methods:

• A rapid realist review synthesized context and mechanism data.
• Clinician feedback refined theoretical propositions through focus groups and interviews.
• Distinguished between implementation resources and clinical reasoning mechanisms.

Main Results:

• The programme theory identified five middle-range propositions.
• Promoting mechanisms included belief in benefits, protocol legitimacy, and team trust.
• Inhibiting mechanisms involved pessimism about the protocol or team; successful implementation required acceptability, feasibility, and adoption.

Conclusions:

• A theory-based approach for sepsis screening implementation was developed using literature and clinician input.
• The programme theory elucidates the 'how' and 'why' of successful clinical intervention implementation.
• This framework can be adapted to improve implementation in other clinical settings.