Trauma Services, Inova Fairfax Medical Campus, Falls Church, Virginia (Dr Newcomb); Department of Occupational Therapy, University of St. Augustine, Austin, Texas (Dr Zadnik); Center for Injury Research and Policy, Johns Hopkins University, Baltimore, Maryland (Mr Carlini, Mss Francis and Staguhn, and Drs Frey and Castillo); RAND Corporation, Pittsburgh, Pennsylvania (Dr Heins); and U.S. Government Accountability Office, Washington, District of Columbia (Ms McNamara).
J Trauma Nurs. 2020 Nov/Dec;27(6):335-345. doi: 10.1097/JTN.0000000000000540.
In 2006, the American College of Surgeons Committee on Trauma mandated implementation of injury prevention programs as a requirement for Level I and II trauma center designation. Little is known about the factors that facilitate or create barriers to establishing evidence-based injury prevention program implementation. The purpose of this research is to generate hypotheses regarding processes used to implement injury prevention programs at trauma centers, identify the factors that facilitate and serve as a barrier to implementation, and develop a model reflecting these factors and relationships.
This is a qualitative study of injury prevention programs at trauma centers. Study participants were chosen from 24 sites representing trauma centers of different patient volumes, geographic regions, and settings in the United States. Subjects participated in phone interviews based on guides developed from pilot interviews with prevention coordinators. Transcribed interviews from eight subjects were analyzed using a system of member checking to code; analysis informed the identification of factors that influence the establishment of evidence-based injury prevention programs.
Five themes emerged from the data analysis: external factors, internal organizational factors, program capacity, program selection, and program success. Analysis revealed that successful program implementation was related to supportive leaders and collaborative, interdepartmental relationships. Additional themes indicated that while organizations were motivated primarily by verification requirements (external factor), strong institutional leadership (internal factor) was lacking. Employee readiness (program capacity) was hindered by limited training opportunities, and programs were often chosen (selection) based on implementation ease rather than evidence base or local data.
Data analysis reveals five emerging themes of program implementation; using these data, we suggest an initial model of barriers and facilitators for implementing evidence-based injury prevention programs that could serve as the springboard for additional research involving a larger representative sample.
2006 年，美国外科医师学会创伤委员会要求实施伤害预防计划，作为一级和二级创伤中心指定的要求。对于促进或为建立循证伤害预防计划实施创造障碍的因素知之甚少。本研究的目的是生成有关在创伤中心实施伤害预防计划所使用的过程的假设，确定促进和作为实施障碍的因素，并开发反映这些因素和关系的模型。
这是一项对创伤中心伤害预防计划的定性研究。研究参与者是从代表不同患者量、地理位置和美国环境的 24 个创伤中心中选择的。研究对象根据与预防协调员进行的试点访谈制定的指南，参加了电话访谈。对来自 8 名参与者的转录访谈进行了分析，使用成员检查系统进行编码；分析结果确定了影响建立循证伤害预防计划的因素。
数据分析中出现了五个主题：外部因素、内部组织因素、计划能力、计划选择和计划成功。分析表明，成功的计划实施与支持性领导和协作、跨部门关系有关。其他主题表明，尽管组织主要受到验证要求（外部因素）的驱动，但缺乏强大的机构领导（内部因素）。员工准备情况（计划能力）受到有限的培训机会的阻碍，并且通常根据实施的容易程度而不是证据基础或当地数据来选择计划。
数据分析揭示了计划实施的五个新出现的主题；使用这些数据，我们提出了一个实施循证伤害预防计划的障碍和促进因素的初始模型，该模型可以作为涉及更大代表性样本的额外研究的基础。
