Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

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dc.contributor.authorJabbour, Mona
dc.contributor.authorCurran, Janet
dc.contributor.authorScott, Shannon D
dc.contributor.authorGuttman, Astrid
dc.contributor.authorRotter, Thomas
dc.contributor.authorDucharme, Francine M
dc.contributor.authorLougheed, M D
dc.contributor.authorMcNaughton-Filion, M L
dc.contributor.authorNewton, Amanda
dc.contributor.authorShafir, Mark
dc.contributor.authorPaprica, Alison
dc.contributor.authorKlassen, Terry
dc.contributor.authorTaljaard, Monica
dc.contributor.authorGrimshaw, Jeremy
dc.contributor.authorJohnson, David W
dc.date.accessioned2013-06-06T19:03:05Z
dc.date.available2013-06-06T19:03:05Z
dc.date.issued2013-05-22
dc.date.updated2013-06-06T19:03:06Z
dc.description.abstractAbstract Background The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. Design/methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. Discussion This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. Trial registration ClinicalTrials.gov: NCT01815710
dc.description.versionPeer Reviewed
dc.identifier.citationImplementation Science. 2013 May 22;8(1):55
dc.identifier.doihttp://dx.doi.org/10.1186/1748-5908-8-55
dc.identifier.urihttp://hdl.handle.net/1993/21421
dc.language.rfc3066en
dc.rightsopen accessen_US
dc.rights.holderMona Jabbour et al.; licensee BioMed Central Ltd.
dc.titleBest strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial
dc.typeJournal Article
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