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Published on: February 19, 2021
A roadmap for applying theoretical frameworks to implementation of hospital rapid response systems: A qualitative
Gerrie Prins1, Soulaiman Lagzimi2, Erwin Ista3
1Department of Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Section Acute Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Introduction:
Rapid response systems (RRSs) are generally associated with a reduction in adverse events in hospital settings. However, limited attention has been given to the use of effective implementation strategies for successfully embedding the RSS in clinical practice.
Objective:
The objective of this study was to identify the barriers and facilitators affecting the reimplementation of the RRS in hospital wards and to develop implementation strategies to address any barriers.
Methods:
We conducted a qualitative study using semistructured focus group interviews with nurses and physicians from nine general wards in a university hospital. Identified barriers and facilitators were categorised using the Tailored Implementation for Chronic Diseases checklist. Based on this categorisation, the Effective Practice and Organisation of Care taxonomy was used to develop ward-specific toolkits.
Results:
A total of 112 determinants influencing the reimplementation of RRS-both facilitators and barriers-were identified and categorised across all seven domains of the Tailored Implementation for Chronic Diseases checklist. The most frequently cited barriers related to the beliefs and behaviours of individual healthcare professionals. Across all wards, half of the proposed implementation strategies fell into the categories of educational materials and meetings or audit and feedback. The remaining strategies spanned a wider range of categories, tailored to the specific needs of each ward.
Conclusions:
This study highlights that effective implementation of an RRS requires consideration of both the behaviour and beliefs of individual healthcare providers, as well as broader organisational issues such as incentives and resources. Successful hospital-wide implementation of an RRS will require a multifaceted approach, combining tailored and educational strategies with components from guideline development and audit and feedback. Further research is needed to determine whether such an approach can lead to successful, sustainable implementation and improved clinical outcomes.
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