التفاصيل البيبلوغرافية
| العنوان: |
Implementation of geriatric screening in the emergency department using the Consolidated Framework for Implementation Research |
| المؤلفون: |
Southerland, Lauren T., Gulker, Peg, Van Fossen, Jenifer, Rine‐Haghiri, Lorri, Caterino, Jeffrey M., Mion, Lorraine C., Carpenter, Christopher R., Cardone, Michael S., Hill, Michael, Hunold, Katherine M. |
| المساهمون: |
Center for Scientific Review |
| المصدر: |
Academic Emergency Medicine ; volume 30, issue 11, page 1117-1128 ; ISSN 1069-6563 1553-2712 |
| بيانات النشر: |
Wiley |
| سنة النشر: |
2023 |
| المجموعة: |
Wiley Online Library (Open Access Articles via Crossref) |
| الوصف: |
Objective Implementation of evidence‐based care processes (EBP) into the emergency department (ED) is challenging and there are only a few studies of real‐world use of theory‐based implementation frameworks. We report final implementation results and sustainability of an EBP geriatric screening program in the ED using the Consolidated Framework for Implementation Research (CFIR). Methods The EBP involved nurses screening older patients for delirium (Delirium Triage Screen), fall risk (4‐Stage Balance Test), and vulnerability (Identification of Seniors at Risk score) with subsequent appropriate referrals to physicians, therapy specialists, or social workers. The proportions of screened adults ≥65 years old were tracked monthly. Outcomes are reported January 2021–December 2022. Barriers encountered were classified according to CFIR. Implementation strategies were classified according to the CFIR‐Expert Recommendations for Implementing Change (ERIC). Results Implementation strategies increased geriatric screening from 5% to 68%. This did not meet our prespecified goal of 80%. Change was sustained through several COVID‐19 waves. Inner setting barriers included culture and implementation climate. Initially, the ED was treated as a single inner setting, but we found different cultures and uptake between ED units, including night versus day shifts. Characteristics of individuals barriers included high levels of staff turnover in both clinical and administrative roles and very low self‐efficacy from stress and staff turnover. Initial attempts with individualized audit and feedback were not successful in improving self‐efficacy and may have caused moral injury. Adjusting feedback to a team/unit level approach with unitwide stretch goals worked better. Identifying early adopters and conducting on‐shift education increased uptake. Lessons learned regarding ED culture, implementation in interconnected health systems, and rapid cycle process improvement are reported. Conclusions The pandemic exacerbated barriers to ... |
| نوع الوثيقة: |
article in journal/newspaper |
| اللغة: |
English |
| DOI: |
10.1111/acem.14776 |
| الإتاحة: |
https://doi.org/10.1111/acem.14776Test |
| حقوق: |
http://creativecommons.org/licenses/by-nc/4.0Test/ |
| رقم الانضمام: |
edsbas.F1223867 |
| قاعدة البيانات: |
BASE |
