Samost-Williams Aubrey, Richter Reed, Vanga Naveen, Mandaloju Spandana, Arandela Adlai, Sridhar Srikanth, Thomas Eric J
Department of Anesthesiology, Critical Care, and Pain Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA.
Outcomes Research Consortium, Houston, TX, USA.
JCA Adv. 2025 Jun;2(2). doi: 10.1016/j.jcadva.2025.100099. Epub 2025 Feb 12.
There frequently exists a gap between known best practices and real-world methods. Closing this gap involves thoughtful implementation, typically involving multiple implementation strategies. Implementation mapping is a technique that links the innovation being implemented with potential barriers to implementation and connects these barriers to the strategies that form the implementation plan. This study demonstrates the application of implementation mapping to guide the adoption of the Epic Health Systems Intraoperative Anesthesia Handoff Report. The objective is to create a comprehensive implementation plan tailored to the anticipated challenges of the local environment. There are five steps in implementation mapping: (1) performing a needs assessment, (2) creating a matrix of change, (3) identifying the mechanisms of change and strategies for change, (4) creating implementation materials, and (5) measuring implementation outcomes. Through the creation of this map, a multi-pronged implementation strategy was created and executed. This implementation plan resulted in high acceptability, appropriateness, and feasibility scores among frontline anesthesia clinicians adopting the intraoperative anesthesia tool. The logical connections between the barriers and the implementation strategies further facilitated changes to the implementation plan as new challenges arose during the implementation process. This study addresses a critical gap in clinical practice by providing a structured approach to implementing best practices in anesthesiology. Implementation mapping can potentially be a valuable technique for guiding quality improvement projects involving implementing new clinical practices in anesthesiology.
已知的最佳实践与实际应用方法之间常常存在差距。弥合这一差距需要精心实施,通常涉及多种实施策略。实施映射是一种将正在实施的创新与实施过程中的潜在障碍联系起来,并将这些障碍与构成实施计划的策略相连接的技术。本研究展示了如何运用实施映射来指导Epic医疗系统术中麻醉交接报告的采用。目标是制定一份针对当地环境预期挑战的全面实施计划。实施映射有五个步骤:(1)进行需求评估;(2)创建变革矩阵;(3)确定变革机制和变革策略;(4)创建实施材料;(5)衡量实施结果。通过创建这一映射,制定并执行了多管齐下的实施策略。该实施计划在采用术中麻醉工具的一线麻醉临床医生中获得了较高的可接受性、适宜性和可行性评分。随着实施过程中出现新的挑战,障碍与实施策略之间的逻辑联系进一步推动了对实施计划的调整。本研究通过提供一种在麻醉学中实施最佳实践的结构化方法,填补了临床实践中的一个关键空白。实施映射可能是指导涉及在麻醉学中实施新临床实践的质量改进项目的一项有价值的技术。