Implementation Efforts Research Articles

Valencia and the Right to Energy approach

Abstract Background Valencian (Spain) vulnerable households are suffering both winter and summer energy poverty. An increasing number of families have difficulties paying energy bills and are being forced to cut consumption, consequently reducing their well-being and quality of life. This study presents the development and implementation of the Right to Energy urban program in the Valencia pilot city, as part of the larger European WELLBASED project. Methods The interventions were designed based on the social ecological model, aiming at impacting the different layers influencing individuals’ health, following co-creation sessions with 6-9 stakeholders from policy, citizens and practice. Implementation efforts were monitored using administration of participation. The experience of the Energy Office was also valuable for the design and implementation phase. Results The program consisted of bill optimization and advice, socio-energetic audit at home and the installation of an efficiency kit. On top of that, the Valencia pilot has created the Citizen School for the Right to Energy [CSRE] to empower households and improve their health through education activities. In total, 130 vulnerable households with different profiles were supported. The CSRE has carried out 28 workshops to train people in energy and health topics: energy rights, healthy diet, mental health, sleep quality or preparation for heat waves. These were an opportunity to share experiences among participants, fighting stigmatization and isolation by creating a community. The CSRE has also organized capacity-building sessions for professionals who can identify energy poverty such as healthcare and social workers, teachers or NGO’s. Conclusions Energy poverty, both winter and summer, is a major public health issue that impacts people’s health. The CSRE is an innovative way to tackle it and promote the Right to Energy across society by supporting and training people to improve their wellbeing.

10.X.2. Strengthening primary health care through best practice transfer: the CIRCE-JA approach

Abstract Primary health care (PHC) is a fundamental component of resilient, strong, and sustainable health systems. The main aim of PHC is to address people’s health in a high-quality comprehensive system approach, ensuring person-centred and integrated care across their lifespan, which includes their physical, mental and social well-being. Following the COVID-19 pandemic, health systems’ strengthening has become a global public health and European public health priority, and an overarching objective of the EU4Health programme. In Feb 2023, the three-year Joint Action on the transfer of best praCtices In pRimary CarE (CIRCE-JA) was launched. Its overall objective is to effectively transfer and implement six identified PHC best practices (BPs) across EU Member States (MS), with scientifically robust evidence-based approach, to ensure sound transferability methodology. Critically, it aims to increase MS capacity to deploy innovative care models in PHC and to effectively support health system transformation at this level of care. CIRCE-JA is a collaborative effort with 14 MS participating, bringing together 48 entities, to initially transfer the identified BPs into 42 new implementation sites, whilst at the same time generate all the necessary tools to facilitate uptake and evidence-informed decision-making across all MS. This implementation is based on the alignment of key BP characteristics to meet the local healthcare needs and priorities and match them with national and regional policies. It aims to facilitate integration of public health priorities to PHC practice, and to support the reorganization of services, for strong health promotion focus, synergies with community care, and better coordination of care. During this session key aspects will be discussed using the Pecha Kucha style, to inform the audience about current progress and CIRCE-JA using short stories, also on EU policies and priorities, and the EU4Health support for PHC and public health integration. What is urgently needed at EU-level when it comes to health systems’ strengthening in the post-COVID-19 period and why is PHC critical in this respect? How can the CIRCE-JA developments inform the ongoing transfer and future efforts for the selected BPs in terms of a robust scientifically evidence-based approach? How does the policy dialogue CIRCE-JA is establishing locally, nationally, regionally, supports not only the JA’s sustainability, but all future implementation efforts for PHC? Finally, a brief interaction with the audience will take a place to allow attendees to discuss on key priorities and challenges in their own settings and practice, including the barriers and difficulties that they have initially identifies in the implementation efforts. The output of this interaction will also inform the initial steps towards the establishment of the final deliverable of CIRCE-JA, i.e., the European Primary Healthcare Observatory, to sit on the European Commission’s Health Policy Platform. Key messages • Health systems’ strengthening necessitates strong PHC. CIRCE-JA delivers state-of-the-art tools and brokers policy dialogue to achieve it across Europe. • Several barriers and issues that facilitate the transferring process have been identified in the first implementation of this European initiative. Speakers/Panelists Christos Lionis CSFM & HSR-PH Lab, Faculty of Medicine, University of Crete, Heraklion, Greece Ana M Carriazo Regional Ministry of Health and Families of Andalusia, Seville, Spain Alice Borghini National Agency for Regional Health Services AGENAS, Rome, Italy Radivoje Pribakovic NIJZ, Ljubljana, Slovenia

Barriers to the application of simulation technologies in the education of health care students

Abstract Simulation technologies (ST) in health and medical education are undergoing rapid development due to the undoubted advantages of the methods and forms of simulation used - high quality, significant efficiency, economy, reliability and safety for the patient. At the same time, the application of ST is still underrepresented in the education of health care students. The main aim of this study was to identify the barriers and perspectives for the application of ST in the education of health professional students in Bulgaria from the perspective of the respondents’ expertise. A qualitative study of the expert (n = 17) opinion of those directly involved in the introduction, application, and evaluation of the use of ST in the education of healthcare students was conducted in 2023 in Varna. The questionnaire regarding the barriers and perspectives in the use of ST in the education of undergraduate and postgraduate students in health specialties students was used. The main barriers to the widespread use of ST in the training of students were identified as follows: the lack of adapted curricula that combine traditional practical sessions with patients and those on simulators; the lack of a sufficient number of trained and motivated trainers; the reluctance of trainers to introduce or more widely use ST; lack of or insufficient space to locate a simulation centre or equipment in relevant core units; the high cost of purchasing and maintaining ST and limited financial resources, as well as the large number of students in the groups. According to one of the experts, ‘there are no barriers to the use of ST, but real patient contact and a personalized approach to the patient is impossible to replicate through technology,’ highlighting the importance in combining traditional training with real patients and modern with the use of technology. Ethical issues in training healthcare professionals with simulators appear to be a new aspect of medical education with the application of ST. Key messages • In the effort for widespread implementation of ST in the training of health professions students, it is important to achieve a balance with traditional training experienced with real patients. • Identifying and overcoming barriers is an important prerequisite for the rapid and widespread application of ST in the training of health care students.

A Process Evaluation in a Randomized Controlled Trial among Adults with Acetabular Dysplasia

Abstract Introduction The 2021 framework from the UK’s Medical Research Council defines evaluation as a theory-driven approach to examine how well an intervention works. However, the application of these guidelines can be challenging. Therefore, using a process evaluation case study on an exercise and patient education intervention for adults with acetabular dysplasia, we reflect on which specific aspects were relevant for the evaluation of the intervention and why. We focus on detailing methods to assess implementation (process, dose, reach), acceptability, mechanisms of change, and the impact of contextual factors. Methods Two hundred trial participants aged 18-50 years will be recruited from a University Hospital in Denmark and randomised to intervention and control groups. The process evaluation adopts a concurrent mixed-methods design involving self-report questionnaires at baseline and 6-month follow-up, training records and semi-structured focus groups with intervention providers (n = 10) and healthcare managers (n = 4-6). The mechanisms of change will be explored through semi-structured one-to-one interviews (at baseline and 6-month follow-up) with 15-20 purposefully sampled trial participants, and additionally, through exploratory examinations of associations between dose and change in health outcomes at 6-month follow-up), via simple linear regression models. The acceptability and contextual factors will be explored through one-to-one participant interviews, plus focus groups with 4-6 healthcare managers. Thematic analyses of the interviews will focus on expectations, experiences, events, personal understandings and interpersonal and organisational interactions. Conclusions The presentation will explore how the operational aspects of the intervention can be assessed through a process evaluation and how these findings may improve and expand any future implementation efforts.

Framework for Implementation of Building Automation Control Programs for Industrial Heating and Cooling Systems

This article proposes a novel framework for the rapid implementation of automation programs in industrial heating and cooling systems. The global push for sustainability necessitates significant infrastructural transformations within these systems, which currently rely heavily on fossil fuels and are responsible for 75% of industrial final energy consumption. Our research highlights the critical role of design patterns and object-oriented programming principles to address the complex integration of additional energy converters and storage into automation programs. By leveraging design patterns, our framework encapsulates the intricacies of various components, such as actuators, sensors, and storage, within a comprehensive object-oriented model that also allows the integration of different control strategies. Qualitatively, this approach enhances the reusability, scalability, and adaptability of automation programs. Therefore, quantitatively, our framework enables a more resilient and efficient energy system. The framework is validated through its application to a complex, cross-linked industrial heating and cooling system at the ETA Research Factory of the Technical University of Darmstadt. Using the developed framework reduces implementation effort significantly due to its consistent and modular structure resulting from the reusable design patterns.

Virtual practice facilitation as an implementation strategy for launching opioid safety committees for quality improvement in primary care: feasibility, acceptability, and intervention fidelity

BackgroundPractice facilitation (PF) is an evidence-based multicomponent in-person implementation strategy. COVID-19-related lockdowns caused many implementation initiatives to rapidly shift to virtual settings, but there is limited evidence on PF deployed exclusively using virtual meeting platforms. Our objective was to assess the feasibility and acceptability of virtual PF used in a primary care setting to implement interdisciplinary opioid safety committees (OSCs) to improve care for patients using opioid medicines for persistent pain and reduce high-dose opioid prescribing. We also describe alignment of virtual PF with the core functions of PF and fidelity of participating clinics to the OSC intervention.MethodsWe applied qualitative and quantitative methods to evaluate virtual PF used to implement a quality improvement project at Kaiser Permanente Washington, an integrated health system in Washington State. We established interdisciplinary OSCs in primary care clinics using virtual PF. OSCs were tasked with promoting opioid safety and high-quality pain care through population management and chart reviews. We used administrative data to calculate feasibility measures including attendance and retention. Acceptability data came from interviews with OSC members conducted by evaluators. Measures of fidelity to the OSC intervention were abstracted from meeting notes and administrative data. We used qualitative methods to assess the adherence of virtual PF to the core functions of PF.ResultsFacilitators carried out a comprehensive PF approach virtually and demonstrated adherence to the core functions of PF. We established OSCs in eight clinics and conducted an average of 17.5 virtual PF meetings over eight months of PF for each clinic. Average attendance was 75% and we had 84% retention. OSC members were highly satisfied with virtual PF. Facilitators effectively supported teams through implementation and technical challenges and OSC members gained skills through virtual PF. We implemented OSCs with high fidelity, suggesting virtual PF is an effective implementation strategy.ConclusionsWe found virtual PF is a feasible and acceptable implementation strategy for this intervention and identified strategies to support care teams through challenges. Our findings can help inform future implementation efforts, especially those hoping to engage geographically dispersed clinics or remote clinical staff.Trial registrationNot applicable.

Whole blood and freeze-dried plasma in Canadian trauma care.

SummaryThis article highlights the crucial role of blood transfusion in trauma care and explores the historical and contemporary use of whole blood and freeze-dried plasma in Canadian health care. Early use of whole blood and freeze-dried plasma during global conflicts led to advancements in transfusion medicine. The transition to blood component therapy improved transfusion safety and precision. However, there is an increasing interest in using whole blood and freeze-dried plasma, supported by recent evidence suggesting potential benefits over blood component therapy, particularly in trauma cases. Canadian initiatives, such as leukoreduced whole blood production for the military, indicate efforts to address logistical challenges in delivering trauma care, especially in remote areas. Challenges remain, including logistical issues and regulatory complexities, requiring coordinated efforts for effective implementation. Overall, there's growing support for integrating whole blood and freeze-dried plasma into trauma care across Canada.

Evergreen Migration for North Carolina Community College Libraries

The migration of North Carolina Community College Libraries to the Evergreen platform is the culmination of planning, training, and implementation efforts of librarians throughout the state over the last four and a half years. This article provides a brief overview of the process and outlines benefits for the 50 participating institutions, before concluding with suggestions for other libraries that are considering a similar migration.

Co-created improvement goals and strategies for implementing SBIRT and MAUDin primary care settings in a facilitator-supported, tailored implementation study.

Evidence-based approaches to screening and treatment for unhealthy alcohol use have the potential to reduce morbidity and mortality but are currently underutilized in primary care settings. To support implementation of screening, brief intervention, and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) by identifying goals co-developed by clinics and practice facilitators in a flexible implementation study. In a pragmatic implementation study, we used practice facilitation to support the implementation of SBIRT and MAUD in 48 clinical practices across Oregon, Washington, and Idaho. Our study used a tailored approach, in which facilitators and clinics co-identified implementation goals based on clinic needs. We used clinic contact logs, individual interviews, group periodic reflections with practice facilitators, and exit interviews with clinic staff to inform qualitative analysis. With support from practice facilitators, clinics identified goals spanning SBIRT, MAUD, reporting, targeted patient outreach, and quality improvement capacity. Goals addressed both the technical (e.g. data tracking) and social (e.g. staff training) aspects of SBIRT and MAUD. A decision tree summarizes emergent findings into a tool to support future implementation of SBIRT in primary care settings. A facilitator-supported, tailored approach to SBIRT implementation enabled clinics to identify a variety of goals to improve SBIRT and MAUD implementation. These identified priorities, along with a decision tree describing the hierarchical structure of these goals, could support future implementation efforts.

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to Advance Context-Specific and Generalizable Knowledge of Implementation Determinants: Case Study of a Digital Contingency Management Platform.

Background Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation. Methods Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation. Results Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts. Conclusions The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

Evaluating a virtual facilitation workshop with antimicrobial stewardship teams within a cluster randomized stepped-wedge trial

BackgroundAntimicrobial stewardship programs (ASP) often function naturally as facilitators within clinical hospital settings, by working with individuals and teams to reduce unnecessary antibiotics. Within implementation science, facilitation has been studied and evaluated as an implementation strategy that can accelerate and improve fidelity to implementation efforts. This study describes a novel, virtual facilitation strategy developed and served as an intervention within the optimizing perioperative antibiotics for children trial (OPERATIC trial). This paper: (1) describes ASP team’s preferences for and use of a facilitation workshop and (2) describes sustained use of facilitation skills throughout the study period.MethodsStudy participants included antimicrobial stewardship team members from the nine children’s hospitals that participated in this study and completed facilitation training. All individuals who completed facilitation training were asked to evaluate the training through an online survey. Additionally, site leads were interviewed by the site coordinator every other month and asked about their team’s use of facilitation skills throughout the rest of the study period. Survey data were managed and coded in R, and qualitative interview data were analyzed using rapid methodology.Results30 individuals, including both physicians and pharmacists, completed the evaluation. Individuals largely rated themselves as novice facilitators (53%). Individuals reported satisfaction with virtual facilitation and identified different components of the workshops as valuable. An additional 108 interviews were performed throughout the study period. These interviews found that facilitators reported using all skills throughout the study period and described varied use of skills over time. All nine sites applied facilitation strategies, team building techniques, and communication/conflict skills at some point during the intervention phase.ConclusionWe describe the use of virtual facilitation as an acceptable and appropriate strategy to enhance facilitation skills for ASP teams working to reduce unnecessary postoperative antibiotics. Participants reported different useful components of facilitation training and described using differing facilitation skills throughout the trial. Overall, the use of facilitation skills continued throughout the duration of the study period. This paper outlines how facilitation training can be conducted virtually in a way that is feasible and acceptable to clinicians.Trial registrationNCT04366440, April 24, 2020.

Analysis of cigar marketing expenditures by product category, placement strategy and geolocation in the USA, from 2017 to 2022

SignificanceThe marketing of cigars, little cigars and cigarillos (CLCCs) and cigar wraps is under-regulated and understudied in the USA. To describe strategies CLCC manufacturers and vendors used to advertise their...

Challenges and recommendations for collecting and quantifying implementation costs in practice: a qualitative interview study

BackgroundThe cost of implementation is typically not accounted for in published economic evaluations, which determine the relative value for money of health innovations and are important for allocating scarce resources. Despite key papers outlining relevant implementation costs, they continue to be under reported in the literature and often not considered in practice. This study sought to understand and outline current practices for capturing the costs associated with implementation efforts, with examples from the digital health setting.MethodsA qualitative study of semi-structured interviews with purposefully sampled experts in implementation science, health economics and/or digital health was conducted. The interview guide was informed by a literature review and was pilot tested. Interviews were digitally recorded and transcribed. A hybrid inductive/deductive framework analysis was conducted using thematic analysis to elicit key concepts related to the research question.ResultsInterviews were conducted with sixteen participants with specialist expertise in implementation science (n = 8), health economics (n = 6), and/or digital health (n = 8). Five participants were experienced in more than one field. Four key themes were elicited from the data: difficulty identifying and collecting implementation cost data; variation in approaches for collecting implementation cost data; the value of implementation costs; and collaboration enables implementation costing. Broadly, while interviewees recognised implementation costs as important, only some costs were considered in practice likely due to the perceived ill-defined boundaries and inconsistencies in terminology. A variety of methods were used to collect and estimate implementation costs; the most frequent approach was staff time tracking. Multidisciplinary collaboration facilitated this process, but the burden of collecting the necessary data was also highlighted.ConclusionsIn current practice, standardised methods are not commonly used for data collection or estimation of implementation costs. Improved data collection through standardised practices may support greater transparency and confidence in implementation cost estimates. Although participants had industry exposure, most were also academic researchers and findings may not be representative of non-academic industry settings.

Survey on the State, Potential, and Obstacles of the Digital Transformation in Human Milk Banks

Digitalization of human milk banking was examined in a survey among participants of the largest German-speaking symposium for human milk banks. Of the 100 participants, 47% were nurses, 23% were physicians, and 3% were midwives. The overwhelming majority (96%) desired more digitalization in their milk bank. The best-digitized processes were clinical results from donors, milk labeling, and milk orders. At the same time, a discrepancy between the maximum conceivable potential and the current implementation of digital transformation became evident. The survey revealed most participants use in-house digital solutions. Potential main advantages of digitalization were cited as efficiency gains, while implementation efforts and security concerns, particularly power outages and cyberattacks, were seen as disadvantages. Financial restraints, personnel shortage, resistance from local IT departments, and legal concerns were perceived as the biggest barriers. Despite these challenges and a critical examination of the disadvantages, the participants expressed strong optimism and a desire for further digitalization in the human milk bank sector.

Contextual factors associated with successful alcohol screening and brief intervention implementation and sustainment in adult primary care

IntroductionHazardous drinking is a public health problem affecting approximately 20 % of the U.S. primary care population. Clinical trials have documented the efficacy and effectiveness of Alcohol Screening and Brief Intervention (ASBI), yet widespread implementation remains elusive, and questions remain regarding optimal implementation and sustainment strategies. Kaiser Permanente Northern California (KPNC) implemented systematic ASBI in adult primary care in mid-2013. We used 8 years of electronic health record (EHR) data, combined with surveys which captured primary care provider perceptions organized into PRISM (Practical, Robust Implementation and Sustainability Model) implementation framework domains (Intervention, External Environment, Implementation Infrastructure, and Recipients), to characterize ASBI implementation and sustainment and test how various factors are associated with ASBI rates. MethodsUsing EHR data, we calculated yearly screening rates of adults with a primary care visit, and brief intervention (BI) rates among those with a positive hazardous drinking screen, (exceeding the age and sex-specific daily and weekly low-risk NIH guidelines (≤3 per day and ≤ 7 per week for women and older men; ≤4 per day and ≤ 14 per week for men 18–65)), across KPNC, from 2014 to 2021. We collected web-based survey data, informed by the PRISM domains, from primary care providers (n = 796; 35.5 % RR) to assess perceptions on ASBI implementation and sustainability. ResultsBetween 1/1/2014 and 12/31/21 there were 5,072,270 completed screenings and 624,167 BIs. After adjusting for patient panel characteristics, we found that facilities with higher Implementation Infrastructure domain scores, indicating more robust implementation capacity, had higher screening and BI rates; facilities with higher Intervention domain scores, indicating positive perceptions of SBIRT evidence, and facilities with higher Recipients domain scores, indicating perceived organizational robustness, clinician culture and management support; and greater perceived patient needs and their likely benefit from SBIRT, had higher BI rates. ConclusionsResults provide information on factors which may facilitate successful ASBI implementation and sustainability and could inform future ASBI implementation efforts in healthcare system settings. In particular, efforts toward bolstering an organization's implementation infrastructure capacity, prior to embarking on implementation of a systematic ASBI program, could potentially help pave the way for successful implementation.

Do companies walk the talk? Commitments and actions in global supply chain labor standards

This article examines the efforts towards implementing minimum labor standards in global supply chains through the lens of corporate social responsibility. The adoption of supplier codes of conduct has driven efforts to monitor and enforce standards within these chains. Nonetheless, challenges persist in translating commitment into action, giving rise to gaps in implementation. We address two critical phenomena: corporations' varying internalization of responsibility to implement labor standards, and the translation of these written commitments into actions. Through two distinct studies, we explore how companies ‘walk the talk’, and navigate the gaps between corporate recognition of responsibility and the establishment of management systems to implement labor standards. The first study demonstrates that a minority of companies are diligent in committing to implement their codes. Only 17% accept a shared responsibility to implement the code, and most companies only refer to audit visits or the termination of supplier contract as mechanisms put in place. The second study does not find conclusive evidence of a correlation between corporate commitments and the evaluation of their corporate sustainability practices in supply chains as evaluated by KnowtheChain. However, results suggest that companies do better when they promote the collaborative approach with suppliers in their implementation efforts.

Process Mapping to Support the Implementation of a Regional Strategy to Address the Opioid Epidemic.

To address the opioid epidemic in Kansas City, Missouri, local health systems sought to implement a referral to peer recovery coaches (PRCs) for clients presenting with opioid use disorder. Client referrals were made primarily through health system emergency departments, where PRCs met clients to facilitate linkages to recovery support for up to twelve months. This study aimed to evaluate and improve program implementation with process mapping at three local health systems. Using a five-phase conceptual framework and three development and implementation domains, providers, administrators, and PRCs were interviewed to identify the process for recognizing clients with opioid use disorders and referring them to PRCs. Serial meetings were held to validate the process maps at three health systems and a distillation of key processes was created to guide future analyses and implementation efforts. A detailed process map for each health system was developed, from which a high-level process map was created to support future implementation efforts. Health system-specific process maps varied, although conceptually coherent elements were identified across each system to diagram a recovery ecosystem to support client referrals to PRCs. By systematically assessing the implementation of the same program across different health systems, critical steps, along with their barriers and facilitators, were identified that can be used to understand the processes of care associated with outcomes and to guide future implementation efforts.

A Qualitative Examination of Clinician Anxiety about Suicide Prevention and Its Impact on Clinical Practice.

Clinician distress about working with patients at risk for suicide is well documented in the literature, yet little work has examined its pervasiveness across clinical settings. We conducted a secondary analysis of qualitative data gathered from 26 clinicians in primary care and outpatient mental health clinics serving both adult and child clients on their perception of evidence-based practice use for suicide screening, assessment, and brief intervention. Qualitative data were coded for any mentions of clinician anxiety or emotional response, and brief quantitative measures were collected to characterize our sample. When discussing broader barriers to implementation, 85% of participants spontaneously mentioned anxiety or heightened emotional responses related to delivering suicide prevention practices to those at risk for suicide. Common themes included low self-efficacy in suicide prevention skills, distress related to escalating care, efforts to alleviate such distress, and difficulty related to tolerating the uncertainty inherent in suicide prevention work. Similarly, while standardized anxiety ratings for participants were consistent with those of non-clinical norming samples, clinicians reported mild to moderate anxiety when screening for suicide risk (M = 3.64, SD = 2.19, Range = 0-8) and engaging in safety planning (M = 4.1, SD = 2.88, Range = 1-7) on post-interview surveys. In contrast, survey responses reflected generally high self-efficacy in their ability to screen for suicide risk (M = 7.66, SD = 1.29, Range = 5.25-10) and engage in safety planning (M = 8.25, SD = 0.87, Range = 7-9.5). Findings highlight pervasiveness of clinician distress when implementing suicide prevention practices and can inform future suicide prevention implementation efforts.

2024 Systematic Review of Evidence-Based Guidelines for Prehospital Care

ABSTRACT Objectives Evidence-based guidelines (EBGs) are widely recognized as valuable tools to aggregate and translate scientific knowledge into clinical care. High-quality EBGs can also serve as important components of dissemination and implementation efforts focused on educating emergency medical services (EMS) clinicians about current evidence-based prehospital clinical care practices and operations. We aimed to perform the third biennial systematic review of prehospital EBGs to identify and assess the quality of prehospital EBGs published since 2021. Methods We systematically searched Ovid Medline and EMBASE from January 1, 2021, to June 6, 2023, for publications relevant to prehospital care, based on an organized review of the literature, and focused on providing recommendations for clinical care or operations. Included guidelines were appraised using the National Academy of Medicine (NAM) criteria for high-quality guidelines and scored using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool. Results We identified 33 new guidelines addressing clinical and operational topics of EMS medicine. The most addressed EMS core content areas were time-life critical conditions (n = 17, 51.5%), special clinical considerations (n = 15, 45%), and injury (n = 12, 36%). Seven (21%) guidelines included all elements of the National Academy of Medicine (NAM) criteria for high-quality guidelines, including the full reporting of a systematic review of the evidence. Guideline appraisals by the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool demonstrated modest compliance to reporting recommendations and similar overall quality compared to previously identified guidelines (mean overall domain score 67%, SD 12%), with Domain 5 (“Applicability”) scoring the lowest of the six AGREE II domains (mean score of 53%, SD 13%). Conclusions This updated systematic review identified and appraised recent guidelines addressing prehospital care and identifies important targets for education of EMS personnel. Continued opportunities exist for prehospital guideline developers to include comprehensive evidence-based reporting into guideline development to facilitate widespread implementation of high-quality EBGs in EMS systems and incorporate the best available scientific evidence into initial education and continued competency activities.

Experience of a tertiary acute care hospital in Southeast Asia in initiating patient engagement with the aid of digital solutions.

With the goal of patient engagement, an initiative was formulated to equip each patient in the general wards with a tablet whereby they can access their health information and patient education materials and communicate with their healthcare team. This paper presented the methodology of the implementation efforts as well as an evaluation of the preliminary outcomes. The process of hospital-wide implementation was shared using the implementation research logic model. The bedside tablets were rolled out hospital-wide in a step-wedge manner over 12 months. Barriers and facilitators to this implementation were discussed together with strategies to optimize the situation. Preliminary outcomes of the implementation were evaluated using the RE-AIM framework. The initial adoption rate for the bedside tablet was low. Additional strategies, such as survey audits and provision of feedback, development of education materials for patients, facilitation, and purposefully re-examining the implementation strategies, were used to improve adoption. The trend of adoption increased over the course of 2 years from the start of implementation. The initial lower adoption rates may reflect Singapore's paternalistic healthcare culture. While this implementation was driven by the need to move away from paternalism and toward patient engagement, more time is required for significant cultural change.