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Rodrigues AM, Nichol B, Wilson R, Charlton C, Gibson B, Finch T, Haighton C, Maniatopoulos G, Giles E, Harrison D, Orange D, Robson C, Harland J. Mapping regional implementation of 'Making Every Contact Count': mixed-methods evaluation of implementation stage, strategies, barriers and facilitators of implementation. BMJ Open 2024; 14:e084208. [PMID: 39038864 PMCID: PMC11268057 DOI: 10.1136/bmjopen-2024-084208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Making Every Contact Count (MECC) programme provides training and materials to support public-facing workers to encourage health-promoting behaviour change by using the day-to-day interactions between organisations and individuals. This project aimed to analyse MECC implementation through a comparative analysis of implementation stage, strategies used for implementation and enablers/barriers of the implementation process within a region in England-the North East and North Cumbria (NENC). METHODS A mixed-methods process evaluation was conducted applying normalisation process theory and theoretical domains framework. MECC programme documents were reviewed and mapped against specific criteria (eg, implementation strategies). An online mapping survey was conducted to establish current implementation/delivery of MECC within NENC settings (eg, local government, healthcare and voluntary community sector). Qualitative research, using individual interviews and group discussions, was conducted to establish further understanding of MECC implementation. RESULTS Our findings were informed by reviewing documents (n=5), surveying participants (n=34), interviews (n=18) and group discussions (n=48). Overall, the implementation of MECC within the region was at an early stage, with training mostly delivered between, rather than within, organisations. Qualitative findings highlighted factors that influence stakeholders to implement MECC (eg, organisational goals that were facilitated by MECC implementation, including the prevention agenda), supported resources that facilitate the implementation of MECC (eg, logic models) and enabling factors that promote MECC sustainability across the region (eg, buy-in from leadership and management). CONCLUSIONS The NENC MECC programme is built around regional leadership that supports the implementation process. This process evaluation identified key influences of MECC implementation across the region. We discuss evidence-based recommendation for policy and practice that can be taken forward to develop targeted strategies to support future MECC implementation. For example, a co-ordinated infrastructure and strategy is needed to combat delivery and implementation issues identified.
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Affiliation(s)
- Angela M Rodrigues
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Bethany Nichol
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | - Rob Wilson
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, UK
| | - Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Beckie Gibson
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Catherine Haighton
- Department of Social Work, Education and Community Wellbeing, Northumbria University Newcastle, Newcastle Upon Tyne, UK
| | | | - Emma Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Deborah Harrison
- Newcastle University Business School, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Orange
- Office for Health Improvement & Disparities, Newcastle upon Tyne, UK
| | - Craig Robson
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Jill Harland
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Voorend CG, Berkhout-Byrne NC, van Bodegom-Vos L, Diepenbroek A, Franssen CF, Joosten H, Mooijaart SP, Bos WJW, van Buren M. Geriatric Assessment in CKD Care: An Implementation Study. Kidney Med 2024; 6:100809. [PMID: 38660344 PMCID: PMC11039322 DOI: 10.1016/j.xkme.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Rationale & Objective Older people with progressive chronic kidney disease (CKD) have complex health care needs. Geriatric evaluation preceding decision making for kidney replacement is recommended in guidelines, but implementation is lacking in routine care. We aimed to evaluate implementation of geriatric assessment in CKD care. Study Design Mixed methods implementation study. Setting & Participants Dutch nephrology centers were approached for implementation of geriatric assessment in patients aged ≥70 years and with an estimated glomerular filtration rate of ≤20 mL/min/1.73 m2. Quality Improvement Activities/Exposure We implemented a consensus-based nephrology-tailored geriatric assessment: a patient questionnaire and professionally administered test set comprising 16 instruments covering functional, cognitive, psychosocial, and somatic domains and patient-reported outcome measures. Outcomes We aimed for implementation in 10 centers and 200 patients. Implementation was evaluated by (i) perceived enablers and barriers of implementation, including integration in work routines (Normalization Measure Development Tool) and (ii) relevance of the instruments to routine care for the target population. Analytical Approach Variations in implementation practices were described based on field notes. The postimplementation survey among health care professionals was analyzed descriptively, using an explanatory qualitative approach for open-ended questions. Results Geriatric assessment was implemented in 10 centers among 191 patients. Survey respondents (n = 71, 88% response rate) identified determinants that facilitated implementation, ie, multidisciplinary collaboration (with geriatricians) -meetings and reports and execution of assessments by nurses. Barriers to implementation were patient illiteracy or language barrier, time constraints, and patient burden. Professionals considered geriatric assessment sufficiently integrated into work routines (mean, 6.7/10 ± 2.0 [SD]) but also subject to improvement. Likewise, the relevance of geriatric assessment for routine care was scored as 7.8/10 ± 1.2. The Clinical Frailty Score and Montreal Cognitive Assessment were perceived as the most relevant instruments. Limitations Selection bias of interventions' early adopters may limit generalizability. Conclusions Geriatric assessment could successfully be integrated in CKD care and was perceived relevant to health care professionals.
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Affiliation(s)
- Carlijn G.N. Voorend
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Noeleen C. Berkhout-Byrne
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Adry Diepenbroek
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Casper F.M. Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke Joosten
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Simon P. Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marjolijn van Buren
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands
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Wan YKJ, Wright MC, McFarland MM, Dishman D, Nies MA, Rush A, Madaras-Kelly K, Jeppesen A, Del Fiol G. Information displays for automated surveillance algorithms of in-hospital patient deterioration: a scoping review. J Am Med Inform Assoc 2023; 31:256-273. [PMID: 37847664 PMCID: PMC10746326 DOI: 10.1093/jamia/ocad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE Surveillance algorithms that predict patient decompensation are increasingly integrated with clinical workflows to help identify patients at risk of in-hospital deterioration. This scoping review aimed to identify the design features of the information displays, the types of algorithm that drive the display, and the effect of these displays on process and patient outcomes. MATERIALS AND METHODS The scoping review followed Arksey and O'Malley's framework. Five databases were searched with dates between January 1, 2009 and January 26, 2022. Inclusion criteria were: participants-clinicians in inpatient settings; concepts-intervention as deterioration information displays that leveraged automated AI algorithms; comparison as usual care or alternative displays; outcomes as clinical, workflow process, and usability outcomes; and context as simulated or real-world in-hospital settings in any country. Screening, full-text review, and data extraction were reviewed independently by 2 researchers in each step. Display categories were identified inductively through consensus. RESULTS Of 14 575 articles, 64 were included in the review, describing 61 unique displays. Forty-one displays were designed for specific deteriorations (eg, sepsis), 24 provided simple alerts (ie, text-based prompts without relevant patient data), 48 leveraged well-accepted score-based algorithms, and 47 included nurses as the target users. Only 1 out of the 10 randomized controlled trials reported a significant effect on the primary outcome. CONCLUSIONS Despite significant advancements in surveillance algorithms, most information displays continue to leverage well-understood, well-accepted score-based algorithms. Users' trust, algorithmic transparency, and workflow integration are significant hurdles to adopting new algorithms into effective decision support tools.
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Affiliation(s)
- Yik-Ki Jacob Wan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Melanie C Wright
- College of Pharmacy, Idaho State University, Meridian, ID 83642, United States
| | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, UT 84112, United States
| | - Deniz Dishman
- Cizik School of Nursing Department of Research, University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Mary A Nies
- College of Health, Idaho State University, Pocatello, ID 83209, United States
| | - Adriana Rush
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
| | - Karl Madaras-Kelly
- College of Pharmacy, Idaho State University, Meridian, ID 83642, United States
| | - Amanda Jeppesen
- College of Pharmacy, Idaho State University, Meridian, ID 83642, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT 84108, United States
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Wong A, Berenbrok LA, Snader L, Soh YH, Kumar VK, Javed MA, Bates DW, Sorce LR, Kane-Gill SL. Facilitators and Barriers to Interacting With Clinical Decision Support in the ICU: A Mixed-Methods Approach. Crit Care Explor 2023; 5:e0967. [PMID: 37644969 PMCID: PMC10461946 DOI: 10.1097/cce.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Clinical decision support systems (CDSSs) are used in various aspects of healthcare to improve clinical decision-making, including in the ICU. However, there is growing evidence that CDSS are not used to their full potential, often resulting in alert fatigue which has been associated with patient harm. Clinicians in the ICU may be more vulnerable to desensitization of alerts than clinicians in less urgent parts of the hospital. We evaluated facilitators and barriers to appropriate CDSS interaction and provide methods to improve currently available CDSS in the ICU. DESIGN Sequential explanatory mixed-methods study design, using the BEhavior and Acceptance fRamework. SETTING International survey study. PATIENT/SUBJECTS Clinicians (pharmacists, physicians) identified via survey, with recent experience with clinical decision support. INTERVENTIONS An initial survey was developed to evaluate clinician perspectives on their interactions with CDSS. A subsequent in-depth interview was developed to further evaluate clinician (pharmacist, physician) beliefs and behaviors about CDSS. These interviews were then qualitatively analyzed to determine themes of facilitators and barriers with CDSS interactions. MEASUREMENTS AND MAIN RESULTS A total of 48 respondents completed the initial survey (estimated response rate 15.5%). The majority believed that responding to CDSS alerts was part of their job (75%) but felt they experienced alert fatigue (56.5%). In the qualitative analysis, a total of five facilitators (patient safety, ease of response, specificity, prioritization, and feedback) and four barriers (excess quantity, work environment, difficulty in response, and irrelevance) were identified from the in-depth interviews. CONCLUSIONS In this mixed-methods survey, we identified areas that institutions should focus on to improve appropriate clinician interactions with CDSS, specific to the ICU. Tailoring of CDSS to the ICU may lead to improvement in CDSS and subsequent improved patient safety outcomes.
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Affiliation(s)
- Adrian Wong
- Beth Israel Deaconess Medical Center, Department of Pharmacy, Boston, MA
| | | | - Lauren Snader
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA
| | - Yu Hyeon Soh
- University of Pittsburgh, School of Pharmacy, Pittsburgh, PA
| | | | | | - David W Bates
- Brigham and Women's Hospital, Division of General Internal Medicine and Primary Care, Boston, MA
- Harvard Medical School, School of Medicine, Boston, MA
| | - Lauren R Sorce
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Northwestern University Feinberg School of Medicine, Division of Pediatric Critical Care, Chicago, IL
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Hammouda N, Neyra JA. Can Artificial Intelligence Assist in Delivering Continuous Renal Replacement Therapy? Adv Chronic Kidney Dis 2022; 29:439-449. [PMID: 36253027 PMCID: PMC9586461 DOI: 10.1053/j.ackd.2022.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 01/25/2023]
Abstract
Continuous renal replacement therapy (CRRT) is widely utilized to support critically ill patients with acute kidney injury. Artificial intelligence (AI) has the potential to enhance CRRT delivery, but evidence is limited. We reviewed existing literature on the utilization of AI in CRRT with the objective of identifying current gaps in evidence and research considerations. We conducted a scoping review focusing on the development or use of AI-based tools in patients receiving CRRT. Ten papers were identified; 6 of 10 (60%) published in 2021, and 6 of 10 (60%) focused on machine learning models to augment CRRT delivery. All innovations were in the design/early validation phase of development. Primary research interests focused on early indicators of CRRT need, prognostication of mortality and kidney recovery, and identification of risk factors for mortality. Secondary research priorities included dynamic CRRT monitoring, predicting CRRT-related complications, and automated data pooling for point-of-care analysis. Literature gaps included prospective validation and implementation, biases ascertainment, and evaluation of AI-generated health care disparities. Research on AI applications to enhance CRRT delivery has grown exponentially in the last years, but the field remains premature. There is a need to evaluate how these applications could enhance bedside decision-making capacity and assist structure and processes of CRRT delivery.
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Affiliation(s)
- Nada Hammouda
- Department of Applied Clinical Research, University of Texas, Southwestern, Dallas, TX
| | - Javier A Neyra
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
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Mikkelsen MLN, Frederiksen MH, Marcussen N, Williams B, Kidholm K. Prior to Implementation of Digital Pathology-Assessment of Expectations among Staff by Means of Normalization Process Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127253. [PMID: 35742502 PMCID: PMC9223804 DOI: 10.3390/ijerph19127253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
The Region of Southern Denmark is the first in Denmark to implement digital pathology (DIPA), starting at the end of 2020. The DIPA process involves changes in workflow, and the pathologist will have to diagnose based on digital whole slide imaging instead of through the traditional use of the conventional light microscope and glass slides. In addition, in the laboratory, the employees will have to implement one more step to their workflow—scanning of tissue. The aim of our study was to assess the expectations and readiness among employees and management towards the implementation of DIPA, including their thoughts and motivations for starting to use DIPA. We used a mixed-method approach. Based on the findings derived from 18 semi-structured interviews with employees from the region’s departments of pathology, we designed a questionnaire, including questions from the normalization measure development tool. The questionnaires were e-mailed to 181 employees. Of these employees, 131 responded to the survey. Overall, they reported feeling sufficiently tech-savvy to be able to use DIPA, and they had high expectations as well as motivation and readiness for the upcoming changes. However, the employees were skeptical regarding the allocation of resources, and few were aware of reports about the effects of DIPA. Based on the findings, it seems to be important to provide not only a thorough introduction to the new intervention and the changes it will entail, but also to continue to ensure that the staff know how it works and why it is necessary to implement.
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Affiliation(s)
- Minne L. N. Mikkelsen
- CIMT—Centre for Innovative Medical Technology, Odense University Hospital, 5000 Odense, Denmark;
- Department of Pathology, Hospital Sønderjylland, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark;
- Department of Pathology, Odense University Hospital, 5000 Odense, Denmark
- Correspondence:
| | - Marianne H. Frederiksen
- Department of Business and Management, University of Southern Denmark, 5230 Odense, Denmark;
| | - Niels Marcussen
- Department of Pathology, Hospital Sønderjylland, University Hospital of Southern Denmark, 6200 Aabenraa, Denmark;
| | - Bethany Williams
- Department of Histopathology, Leeds Teaching Hospitals NHS Trust and the University of Leeds, Leeds LS2 9JT, UK;
| | - Kristian Kidholm
- CIMT—Centre for Innovative Medical Technology, Odense University Hospital, 5000 Odense, Denmark;
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May CR, Albers B, Bracher M, Finch TL, Gilbert A, Girling M, Greenwood K, MacFarlane A, Mair FS, May CM, Murray E, Potthoff S, Rapley T. Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development. Implement Sci 2022; 17:19. [PMID: 35193611 PMCID: PMC8861599 DOI: 10.1186/s13012-022-01191-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/18/2022] [Indexed: 04/03/2023] Open
Abstract
Background Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. Objectives (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. Method Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. Results A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. Conclusion The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01191-x.
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May CR, Albers B, Bracher M, Finch TL, Gilbert A, Girling M, Greenwood K, MacFarlane A, Mair FS, May CM, Murray E, Potthoff S, Rapley T. Translational framework for implementation evaluation and research: a normalisation process theory coding manual for qualitative research and instrument development. Implement Sci 2022. [PMID: 35193611 DOI: 10.1186/s13012-022-01191-x.pmid:35193611;pmcid:pmc8861599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Normalisation Process Theory (NPT) is frequently used to inform qualitative research that aims to explain and evaluate processes that shape late-stage translation of innovations in the organisation and delivery of healthcare. A coding manual for qualitative researchers using NPT will facilitate transparent data analysis processes and will also reduce the cognitive and practical burden on researchers. OBJECTIVES (a) To simplify the theory for the user. (b) To describe the purposes, methods of development, and potential application of a coding manual that translates normalisation process theory (NPT) into an easily usable framework for qualitative analysis. (c) To present an NPT coding manual that is ready for use. METHOD Qualitative content analysis of papers and chapters that developed normalisation process theory, selection and structuring of theory constructs, and testing constructs against interview data and published empirical studies using NPT. RESULTS A coding manual for NPT was developed. It consists of 12 primary NPT constructs and conforms to the Context-Mechanism-Outcome configuration of realist evaluation studies. Contexts are defined as settings in which implementation work is done, in which strategic intentions, adaptive execution, negotiating capability, and reframing organisational logics are enacted. Mechanisms are defined as the work that people do when they participate in implementation processes and include coherence-building, cognitive participation, collective action, and reflexive monitoring. Outcomes are defined as effects that make visible how things change as implementation processes proceed and include intervention mobilisation, normative restructuring, relational restructuring, and sustainment. CONCLUSION The coding manual is ready to use and performs three important tasks. It consolidates several iterations of theory development, makes the application of NPT simpler for the user, and links NPT constructs to realist evaluation methods. The coding manual forms the core of a translational framework for implementation research and evaluation.
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Affiliation(s)
- Carl R May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine & NIHR North Thames ARC, London, UK.
| | - Bianca Albers
- Institute for Implementation Science in Healthcare, Zurich, Switzerland
| | - Mike Bracher
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Tracy L Finch
- Department of Nursing, Midwifery & Health, Northumbria University & NIHR ARC North East-North Cumbria, Newcastle, UK
| | - Anthony Gilbert
- Royal National Orthopaedic Hospital, London & NIHR North Thames ARC, London, UK
| | - Melissa Girling
- Department of Nursing, Midwifery & Health, Northumbria University & NIHR ARC North East-North Cumbria, Newcastle, UK
| | | | - Anne MacFarlane
- School of Medicine and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Frances S Mair
- Institute of Health and Wellbeing, Glasgow University, Glasgow, UK
| | | | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London & NIHR North Thames ARC, London, UK
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University & NIHR ARC North East- North Cumbria, Newcastle, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University & NIHR ARC North East- North Cumbria, Newcastle, UK
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Spencer S, Dickson F, Sofroniadou S, Naudeer S, Bhandari S, Hazara AM. The impact of e-alerts on inpatient diagnosis and management of acute kidney injury. Br J Hosp Med (Lond) 2021; 82:1-11. [PMID: 33646040 DOI: 10.12968/hmed.2020.0213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS/BACKGROUND Electronic alerts can help with the early detection of acute kidney injury in hospitalised patients. Evidence for their role in improving patient care is limited. The authors have completed an audit loop to evaluate the impact of electronic alerts, and an associated acute kidney injury management pathway, on patient care. METHODS The audits were conducted at a large tertiary care hospital in the UK. Case notes were reviewed for 99 patients over two periods: pre-alert (in 2013; n=55) and post-alert (in 2018; n=44), using the same methodology. Patients for case note reviews were randomly chosen from the list of acute kidney injury alerts generated by the local laboratory information management system. RESULTS Recognition of acute kidney injury, as documented in the case notes, increased from 15% to 43% between the two periods. Time to first medical review (following electronic alerts) improved by 17 minutes (median 4 hours 4 minutes in 2013 vs 3 hours 47 minutes in 2018). Completion of pre-defined acute kidney injury assessment tasks (review of vital signs, biochemistry and acid-base parameters, evidence of fluid balance assessment, consideration of possible sepsis, and examination or requesting urinalysis) improved in 2018. However, acute kidney injury management tasks (correction of hypovolaemia, addressing or investigating obstruction, medications review, renal referral, requesting of further biochemical tests, addressing possible sepsis) showed very little or no improvement. CONCLUSIONS The introduction of acute kidney injury electronic alerts and management pathway resulted in improved recognition and initial assessment of patients with acute kidney injury. Further steps are needed to translate this in to improved patient management.
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Affiliation(s)
- Sebastian Spencer
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Fay Dickson
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Sofia Sofroniadou
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Sarah Naudeer
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, Hull, UK
| | - Adil M Hazara
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Hull York Medical School, Hull, UK
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