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An Implementation Science Approach to Introducing the National Emergency Airway Registry for Pediatric Emergency
Robyn Wing1, D Grace Smith2, E Ruby Cramer3
1Departments of Emergency Medicine and Pediatrics, Division of Pediatric Emergency Medicine, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island, USA.
Insights
Implementing a preintubation checklist in pediatric emergency departments requires understanding implementation barriers and facilitators. Key barriers include staff turnover and resistance, while facilitators involve training and leadership.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Quality Improvement
- Implementation Science
Background:
- The National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) developed a preintubation checklist.
- Successful implementation of quality improvement tools is crucial for better patient outcomes.
Purpose of the Study:
- To conduct a formative evaluation using the Consolidated Framework for Implementation Research (CFIR).
- To identify and assess implementation facilitators and barriers for a preintubation checklist in pediatric emergency departments.
Main Methods:
- Qualitative data collected via focus groups with interprofessional teams (physicians, nurses, pharmacists, respiratory therapists).
- Analysis used the framework matrix approach, coding barriers and facilitators using CFIR domains and constructs.
- Four purposefully sampled NEAR4PEM sites were utilized.
Main Results:
- Prominent barriers identified: high staff turnover, team resistance to change, and perceived lack of need for the checklist.
- Prominent facilitators identified: adequate staff training, clear leadership, effective communication, and checklist adaptability.
Conclusions:
- Multilevel implementation determinants were identified to inform an implementation blueprint.
- Future steps include checklist implementation with concurrent evaluation of outcomes.
Objectives:
The National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) developed an evidence-based preintubation checklist, but translating this quality improvement tool into improved intubation outcomes in the Pediatric Emergency Department requires attention to implementation. To optimize successful implementation, it is essential to understand multilevel implementation determinants. The objective of this study was to conduct a formative evaluation using the Consolidated Framework for Implementation Research (CFIR) to identify and assess implementation facilitators and barriers.
Methods:
Data were collected using focus groups. Qualitative analysis was performed using the framework matrix approach. Interprofessional focus groups composed of physicians, nurses, pharmacists, and respiratory therapists were conducted at 4 purposefully sampled NEAR4PEM sites to represent varying annual visit volume, geographic location, and prior checklist experience. Barriers and facilitators were coded using CFIR domains and constructs and grouped into clinically relevant themes.
Results:
Nineteen key informants from 4 hospital systems noted facilitators and barriers across CFIR domains. Prominent barriers included high staff turnover, team resistance to change, and perceived lack of need for a checklist. Prominent facilitators included adequate staff training, clear identification of a leader, communication and delivery to all key informants, and adaptability of the checklist.
Conclusion:
Data about multilevel implementation determinants were identified to support the ongoing creation and use of an implementation blueprint, a comprehensive plan for strategies, goals, timelines, and key personnel. Future steps involve the implementation of the checklist with concurrent evaluation of implementation and patient outcomes.
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