Abstract
BackgroundImplementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children.MethodsWe conducted a scoping review using Arksey and O’Malley’s framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies.ResultsWe included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%).ConclusionsStudies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that ‘dissemination’ is the most common strategy used, and ‘capacity building and scale-up’ are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.
Highlights
While it would be ideal, not all hospitals have a separate pediatric emergency department (ED), and a significant number of children present at the general emergency departments (EDs) [1, 2]
This review suggests that ‘dissemination’ is the most common strategy used, and ‘capacity building and scale-up’ are the most effective strategies
Implementation strategies are methods or techniques used to enhance the uptake and sustainability of research findings into routine practice [4]. They can be categorized into the following classes: (1) dissemination strategies: actions that target healthcare providers’ awareness, knowledge, attitudes, and intention to adopt an evidence-based intervention (EBI) [5], (2) process strategies: activities or processes related to quality improvement in planning, selecting and integrating EBI into practice [6], (3) integration strategies: activities or actions taken to address factors that positively or negatively influence optimal integration of specific EBI into practice [5], and (4) capacity building and scale-up strategies: strategies that target the general capacity of individuals to execute implementation process strategies [5]
Summary
Implementation strategies are methods or techniques used to enhance the uptake and sustainability of research findings into routine practice [4] They can be categorized into the following classes: (1) dissemination strategies: actions that target healthcare providers’ awareness, knowledge, attitudes, and intention to adopt an evidence-based intervention (EBI) [5], (2) process strategies: activities or processes related to quality improvement in planning, selecting and integrating EBI into practice [6], (3) integration strategies: activities or actions taken to address factors that positively or negatively influence optimal integration of specific EBI into practice [5], and (4) capacity building and scale-up strategies: strategies that target the general capacity of individuals to execute implementation process strategies [5]. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children
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