Doherty Steven
University Department of Rural Health, University of Newcastle, Australia and National Institute of Clinical Studies, Tamworth Base Hospital, Tamworth, Australia [corrected]
Int J Health Care Qual Assur Inc Leadersh Health Serv. 2006;19(1):32-41. doi: 10.1108/09526860610642582.
There is evidence that some strategies for guideline implementation are more successful than others. This paper aims to describe the process of developing an evidence-based guideline implementation strategy for use in rural emergency departments.
DESIGN/METHODOLOGY/APPROACH: Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge translation. Attendance at these workshops, associated reading and a literature review allowed those implementation strategies with the most supportive evidence of effectiveness to be determined.
A multi-faceted implementation strategy was developed. This strategy involved the use of an implementation team as well as addressing issues surrounding individual clinicians, the "emergency department team", the physical structure and processes of the ED and the culture of the department as a whole. Reminders, audit and feedback, education, the use of opinion leaders, and evidence-based formatting of guidelines were all integral to the process.
It is postulated that an evidence-based implementation strategy will lead to greater changes in clinician behaviour than other strategies used in quality improvement projects.
ORIGINALITY/VALUE: This is an important article as it describes the concept and development of evidence-based interventions, which, if tailored to the individual hospital (as evidence-based medicine is tailored to the individual patient), has the potential to improve compliance with clinical guidelines beyond that achieved with most QI projects.
有证据表明，一些指南实施策略比其他策略更成功。本文旨在描述制定一种基于证据的指南实施策略以供农村急诊科使用的过程。
设计/方法/途径：参与一项由国家资助的研究奖学金项目，包括参加由知识转化领域国际知名专家举办的研讨会。参加这些研讨会、相关阅读和文献综述有助于确定那些有最有力有效性证据支持的实施策略。
制定了一个多方面的实施策略。该策略包括组建一个实施团队，以及解决围绕个体临床医生、“急诊科团队”、急诊科的物理结构和流程以及整个科室文化等方面的问题。提醒、审核与反馈、教育、意见领袖的运用以及指南的循证格式化都是该过程不可或缺的部分。
据推测，与质量改进项目中使用的其他策略相比，基于证据的实施策略将导致临床医生行为发生更大的改变。
原创性/价值：这是一篇重要的文章，因为它描述了循证干预措施的概念和发展，如果针对个别医院进行调整（就像循证医学针对个体患者进行调整一样），有可能比大多数质量改进项目更能提高对临床指南的依从性。
