Department of Operation and Intensive Care, Halland Hospital, Halmstad, Sweden.
Lund University, Lund, Sweden.
BMC Health Serv Res. 2024 Aug 21;24(1):965. doi: 10.1186/s12913-024-11423-z.
The Scandinavian Neurotrauma Committee guideline (SNC-16) was developed and published in 2016, to aid clinicians in management of pediatric head injuries in Scandinavian emergency departments (ED). The objective of this study was to explore determinants for use of the SNC-16 guideline by Swedish ED physicians.
This is a nationwide, cross-sectional, web-based survey in Sweden. Using modified snowball sampling, physicians managing children in the ED were invited via e-mail to complete the validated Clinician Guideline Determinants Questionnaire between February and May, 2023. Baseline data, data on enablers and barriers for use of the SNC-16 guideline, and preferred routes for implementation and access of guidelines in general were collected and analyzed descriptively and exploratory with Chi-square and Fisher's tests.
Of 595 invitations, 198 emergency physicians completed the survey (effective response rate 33.3%). There was a high reported use of the SNC-16 guideline (149/195; 76.4%) and a strong belief in its benefits for the patients (188/197; 95.4% agreement). Respondents generally agreed with the guideline's content (187/197; 94.9%) and found it easy to use and navigate (188/197; 95.4%). Some respondents (53/197; 26.9%) perceived a lack of organizational support needed to use the guideline. Implementation tools may be improved as only 58.9% (116/197) agreed that the guideline includes such. Only 37.6% (74/197) of the respondents agreed that the guideline clearly describes the underlying evidence supporting the recommendation. Most respondents prefer to consult colleagues (178/198; 89.9%) and guidelines (149/198; 75.3%) to gain knowledge to guide clinical decision making. Four types of enablers for guideline use emerged from free-text answers: ease of use and implementation, alignment with local guidelines and practice, advantages for stakeholders, and practicality and accessibility. Barriers for guideline use were manifested as: organizational challenges, medical concerns, and practical concerns.
The findings suggest high self-reported use of the SNC-16 guideline among Swedish ED physicians. In updated versions of the guideline, focus on improving implementation tools and descriptions of the underlying evidence may further facilitate adoption and adherence. Measures to improve organizational support for guideline use and involvement of patient representatives should also be considered.
斯堪的纳维亚神经创伤委员会指南（SNC-16）于 2016 年制定并发布，旨在帮助斯堪的纳维亚急诊部门（ED）的临床医生管理儿科头部损伤。本研究的目的是探讨瑞典 ED 医生使用 SNC-16 指南的决定因素。
这是一项全国性的、基于网络的瑞典横断面调查。使用改良的雪球抽样法，通过电子邮件邀请管理急诊科儿童的医生于 2023 年 2 月至 5 月之间填写经验证的临床医生指南决定因素问卷。收集并分析了基线数据、使用 SNC-16 指南的促进因素和障碍、以及一般指南的实施和获取途径的偏好，并进行了描述性和探索性的卡方和 Fisher 检验。
在 595 份邀请中，198 名急诊医师完成了调查（有效应答率 33.3%）。报告的 SNC-16 指南使用率很高（149/195；76.4%），并且医生强烈认为该指南对患者有益（188/197；95.4%的一致性）。受访者普遍同意该指南的内容（187/197；94.9%），并认为该指南易于使用和导航（188/197；95.4%）。一些受访者（53/197；26.9%）认为缺乏使用该指南所需的组织支持。实施工具可能需要改进，因为只有 58.9%（116/197）的受访者同意该指南包含此类工具。只有 37.6%（74/197）的受访者同意该指南清楚地描述了支持建议的基础证据。大多数受访者更愿意咨询同事（178/198；89.9%）和指南（149/198；75.3%）以获取知识来指导临床决策。从自由文本答案中出现了四种使用指南的促进因素：易用性和可实施性、与当地指南和实践的一致性、对利益相关者的优势，以及实用性和可及性。使用指南的障碍表现为：组织挑战、医疗问题和实际问题。
研究结果表明，瑞典 ED 医生自我报告的 SNC-16 指南使用率较高。在指南的更新版本中，关注改进实施工具和描述基础证据可能会进一步促进采用和遵守。还应考虑采取措施改善对指南使用的组织支持和患者代表的参与。
