Department of Emergency Medicine, Gold Coast Health, 1 Hospital Blvd, Southport, QLD, 4215, Australia.
Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, QLD, Australia.
BMC Health Serv Res. 2020 Jan 31;20(1):74. doi: 10.1186/s12913-020-4923-2.
Guideline-based processes for the assessment of chest pain are lengthy and resource intensive. The IMProved Assessment of Chest Pain Trial (IMPACT) protocol was introduced in one Australian hospital Emergency Department (ED) to more efficiently risk stratify patients. The theoretical domains framework is a useful approach to assist in identifying barriers and facilitators to the implementation of new guidelines in clinical practice. The aim of this study was to understand clinicians' perceptions of facilitators and barriers to the use of the IMPACT protocol.
Guided by the theoretical domains framework, semi-structured interviews with nine ED clinical staff (medical and nursing) were undertaken in 2016. Content analysis was conducted independently by two researchers to identify those theoretical domains that facilitated or hindered protocol use.
Domains most often reported as fundamental to the use of the IMPACT protocol included 'social/professional role and identity', 'environmental context and resources' and 'social influences'. These factors seemingly influenced professional confidence, with participants noting 'goals' that included standardisation of practice, enhanced patient safety, and reduced need for unnecessary testing. The domain 'environmental context and resources' also contained the most noted barrier - the need to inform new members of staff regarding protocol use. Opportunities to overcome this barrier included modelling of protocol use by staff at all levels and education - both formal and informal.
A range of domains were identified by ED staff as influencing their chest pain management behaviour. Fundamental to its use were champions/leaders that were trusted and accessible, as well as social influences (other staff within ED and other specialty areas) that enabled and supported protocol use. Research investigating the implementation and perceived use of the protocol at other sites, of varied geographical locations, is warranted.
基于指南的胸痛评估流程冗长且资源密集。IMProved Assessment of Chest Pain Trial（IMPACT）方案在澳大利亚一家医院急诊科引入，以更有效地对患者进行风险分层。理论领域框架是一种有用的方法，可以帮助确定在临床实践中实施新指南的障碍和促进因素。本研究旨在了解临床医生对使用 IMPACT 方案的促进因素和障碍的看法。
在理论领域框架的指导下，于 2016 年对 9 名急诊科临床工作人员（医疗和护理）进行了半结构化访谈。两名研究人员独立进行内容分析，以确定促进或阻碍方案使用的理论领域。
被报告为使用 IMPACT 方案的基础的领域包括“社会/职业角色和身份”、“环境背景和资源”和“社会影响”。这些因素似乎影响了专业人员的信心，参与者指出“目标”包括规范实践、提高患者安全性和减少不必要的测试。“环境背景和资源”这一领域也包含了最多的障碍——需要向新员工告知方案的使用。克服这一障碍的机会包括各级员工的示范和教育——包括正式和非正式的教育。
急诊科工作人员确定了一系列影响胸痛管理行为的领域。方案使用的基础是可信赖和可及的拥护者/领导者，以及支持和促进方案使用的急诊科内部和其他专业领域的社会影响。有必要研究在其他地理位置不同的地点实施和感知使用该方案的情况。
