Getting the timing right: An implementation study and pre post audit to implement evidence-based parathyroid scan...

Clinical practice guidelines are an important mechanism for synthesising evidence for healthcare providers, but implementing the required changes in procedures to align with evidence in nuclear medicine and other healthcare fields is challenging. This study aimed to describe and evaluate an implementation strategy combining principles of implementation science with a modified quality improvement framework to efficiently align clinical guideline recommendations with practice for the timing of parathyroid scintigraphy scan phases, in a public hospital nuclear medicine service.

A structured process using a framework based on a modified version of the A3 tool for improvement tailored for evidence translation using implementation science principles was used to close the gap between practice and evidence-based guidelines. Barriers to translation were explored and an implementation strategy developed. The impact of the change was evaluated using a pre-post audit of routinely collected data.

Working through the modified A3 framework, the team identified barriers including lack of alignment between the local protocol and European Association of Nuclear Medicine (EANM) guidelines; lack of knowledge of the guidelines among nuclear medicine technologists; scheduling barriers; and resistance from physicians. Targeted strategies were successfully implemented to address these barriers focusing on the COM-B domains of capability (education), opportunity (update to policies and procedures) and motivation (feedback and celebration of success). The audit of delayed scan timing indicated improved compliance with the EANM guidelines from 18% pre-intervention to 98% post-intervention (OR 205.3, 95% CI 24.9 to 1691.7, p < 0.01).

This study demonstrated successful implementation of updated recommendations from the EANM guideline in a nuclear medicine department of a large metropolitan health network using a robust intervention for evidence translation. Similar approaches, bringing together elements of continuous improvement tools, implementation science and research methodology, could be used to improve other aspects of evidence-based practice in nuclear medicine.