LO71: Implementation strategies to promote provider behaviour change in emergency departments

Abstract

Introduction: Translating research evidence into routine clinical practice in emergency departments (EDs) often requires changing the behavior(s) of one or more member of the healthcare team. Changing strongly entrenched behavior patterns or occasional behaviors that are impacted by psychological, social or environmental factors can be challenging. We conducted a systematic review of the literature to identify implementation strategies that have been evaluated to change ED provider behavior and promote the uptake of evidence in emergency practice settings. Methods: The following databases were systematically searched from inception to 2017 with the support of a library scientist: MEDLINE, CINAHL, Embase and Cochrane CENTRAL. We also manually searched the last 5 years of Annals of Emergency Medicine, Canadian Journal of Emergency Medicine, and Implementation Science. Studies were assessed by two independent reviewers and retained if they included one or more of the implementation strategies listed in the Cochrane Effective Practice and Organization of Care (EPOC) Taxonomy, targeted any health care provider working in any type of emergency department. The Cochrane Risk of Bias tool was used to assess study quality. Results: Following review of 13,000 title and abstracts, 33 studies met the inclusion criteria. The majority of included studies were randomized control trials (N=32) and 50% were published in the last seven years. Although poorly described, interventions targeted either physicians (n=12), nurses (n=8), pharmacists (n=1) or multi-disciplinary teams (n=12). Common behavioral targets included compliance with practice guidelines, test ordering and prescribing. According to the EPOC Taxonomy most implementation strategies were multi-component and could be categorized as either educational materials/meetings and/or reminders. Only one study author reported using evidence to inform the design of the implementation strategy. Effect sizes varied across relevant study outcomes but the direction of effect was positive in 22/33 included studies. Heterogeneity of study interventions and outcomes precluded meta-analysis. Conclusion: To strengthen the evidence base regarding implementation strategies that promote provider behavior change across different ED contexts, there is a critical need to improve both the design and reporting of implementation strategies in ED research.