Abstract
Background: Early detection of adults at risk of adverse outcomes through systematic screening in the emergency department (ED) can serve to identify high risk groups in need of targeted assessment and early intervention in the hospital or community setting. However, issues such as time pressures, inadequate resources, poor integration of tools into clinical workflow and lack of staff training are cited among the barriers to successfully implementing screening tools in the ED. The aim of this qualitative evidence synthesis (QES) is to synthesize evidence pertaining to the barriers and facilitators to implementing screening tools in the ED. Methods: A comprehensive literature search will be completed in the following databases Scopus, CINAHL, Medline, Embase, Pubmed and Cochrane library. Grey literature sources will also be searched. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of stakeholders on the implementation of screening tools in the ED will be included. “Best fit” framework synthesis will be utilised to produce a context specific conceptual model to describe and explain how these barriers and facilitators may impact on implementation. An a priori framework of themes, formed from the existing evidence base, will inform the ultimate thematic analysis and assist in the organisation and interpretation of search results, ensuring the QES is built upon current findings. CASP will be utilised to quality appraise articles and GRADE CERQual will assess confidence in the QES findings. Conclusions: This synthesis will offer a new conceptual model for describing the perspectives, perceptions and experiences of barriers and facilitators experienced by patients and key stakeholders involved in the implementation of screening tools in the ED. The results of this review will inform practice and aid the development and implementation of change strategies to support the implementation of screening tools in the ED. Registration: PROSPERO CRD42020188712 05/07/20
Highlights
The problem of emergency department (ED) crowding is well recognised and includes significant negative consequences, including adverse patient outcomes and staffs’ inability to adhere to evidence-based treatment (Morley et al, 2018)
In the BeHEMoth strategy (Table 2) the H-Health context is stated as Emergency Department
See page 3 lines 4 and 5, Pg 3 Conclusions Section and Pg 4 Paragraph 3 Sentences 6, 7 and 8. ○ With regards to the barriers and facilitators referenced, the background information referenced organisational, professional and patient associated barriers identified by those involved in the screening process i.e. healthcare workers
Summary
The problem of ED crowding is well recognised and includes significant negative consequences, including adverse patient outcomes and staffs’ inability to adhere to evidence-based treatment (Morley et al, 2018). It is vital to identify barriers and facilitators to the implementation of screening tools to ensure adequate uptake among staff and ensure systematic screening (Kirk et al, 2016) This would be strengthened by giving the reader a sense of the strength of existing evidence. Detection of adults at risk of adverse outcomes through systematic screening in the emergency department (ED) can serve to identify high risk groups in need of targeted assessment and early intervention in the hospital or community setting Issues such as time pressures, inadequate resources, poor integration of tools into clinical workflow and lack of staff training are cited among the barriers to successfully implementing screening tools in the ED. Conclusions: This synthesis will offer a new conceptual model for describing the perspectives, perceptions and experiences of barriers version 2 (revision)
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