Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework

Abstract

Aim. The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team. Background. A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed. Design. Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. Methods. The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. Results. Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. Conclusions. Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived. Relevance for clinical practice. The results show that different cultures exist in the same local context and influence the perception of barriers and facilitators difWhat does this paper contribute to the wider global community?• Culture forms professional role and identity, actions and sense making and provides different ways to perceive barriers and facilitators linked to new screening tools.• This emphasises the importance of understanding the local culture before any implementation strategy linked to screening tools is planned.• As researchers, we have to understand how new tools makes sense in a cultural context before planning any implementation strategies. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes

“…Implementation involving IT innovations often faced barriers related to the hospital’s ability to accommodate new systems [ 6 ]. A final barrier was the popularity of interventions in hospital wards, which results in staff reporting fatigue toward new initiatives [ 6 ] or feelings of tension when juggling hospital priorities alongside intervention goals [ 37 , 38 ].…”

“…Low levels of commitment often occurred in response to structural changes, such as high turnover, which left staff feeling demoralized and unable to accept additional challenges required by implementing the intervention [ 30 ]. Support from management regarding the importance of change and organization-level commitment to new processes was crucial to combating this [ 38 – 40 ]. Several interventions also used champions or coordinators to facilitate motivation [ 39 ], although some staff reported experiencing negativity from colleagues as a barrier to carrying out this role effectively [ 27 ].…”

Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A theory-based process evaluation

“…The TDF was developed for implementation research across multiple disciplines, and use in behaviour change research [17][18][19]. The framework was validated with behaviour change experts [18] and has been used to investigate barriers and enablers to intervention implementation in variety of clinical situations including: blood transfusion [20], preoperative testing [21], hand hygiene compliance [22], screening in the emergency department [23], and electronic fetal health surveillance [24]. The TDF, to our knowledge, has not been used in implementation studies addressing CAUTI.…”

Effective publication strategies in clinical research

“…Researchers are aware that their publication metrics are being used in tenure track assessments, grant applications and job interviews and target them accordingly [8][9][10][11][12][13][14]. Any metric that can be measured, can be gamed and naturally, there are many methods in use whose principle aim is to boost the h-index, h, [15,16] number of publications, N P , [17,18] and number of citations, N C [19,20].…”