Please use this identifier to cite or link to this item: https://repository.monashhealth.org/monashhealthjspui/handle/1/35188
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dc.contributor.authorGerraty R.en
dc.contributor.authorFitzgerald M.en
dc.contributor.authorMiddleton S.en
dc.contributor.authorD'Este C.en
dc.contributor.authorWard J.en
dc.contributor.authorMcInnes E.en
dc.contributor.authorDale S.en
dc.contributor.authorCraig L.en
dc.contributor.authorPhillips R.en
dc.contributor.authorFasugba O.en
dc.contributor.authorSchadewaldt V.en
dc.contributor.authorCheung N.W.en
dc.contributor.authorCadilhac D.A.en
dc.contributor.authorGrimshaw J.M.en
dc.contributor.authorLevi C.en
dc.contributor.authorConsidine J.en
dc.contributor.authorMcElduff P.en
dc.date.accessioned2021-05-14T11:53:01Zen
dc.date.available2021-05-14T11:53:01Zen
dc.date.copyright2020en
dc.date.created20201111en
dc.date.issued2020-11-11en
dc.identifier.citationImplementation science : IS. 15 (1) (pp 99), 2020. Date of Publication: 04 Nov 2020.en
dc.identifier.issn1748-5908 (electronic)en
dc.identifier.urihttps://repository.monashhealth.org/monashhealthjspui/handle/1/35188en
dc.description.abstractBACKGROUND: The implementation of evidence-based protocols for stroke management in the emergency department (ED) for the appropriate triage, administration of tissue plasminogen activator to eligible patients, management of fever, hyperglycaemia and swallowing, and prompt transfer to a stroke unit were evaluated in an Australian cluster-randomised trial (T3 trial) conducted at 26 emergency departments. There was no reduction in 90-day death or dependency nor improved processes of ED care. We conducted an a priori planned process influential factors that impacted upon protocol uptake. METHOD(S): Qualitative face-to-face interviews were conducted with purposively selected ED and stroke clinicians from two high- and two low-performing intervention sites about their views on factors that influenced protocol uptake. All Trial State Co-ordinators (n = 3) who supported the implementation at the 13 intervention sites were also interviewed. Data were analysed thematically using normalisation process theory as a sensitising framework to understand key findings, and compared and contrasted between interviewee groups. RESULT(S): Twenty-five ED and stroke clinicians, and three Trial State Co-ordinators were interviewed. Three major themes represented key influences on evidence uptake: (i) Readiness to change: reflected strategies to mobilise and engage clinical teams to foster cognitive participation and collective action; (ii) Fidelity to the protocols: reflected that beliefs about the evidence underpinning the protocols impeded the development of a shared understanding about the applicability of the protocols in the ED context (coherence); and (iii) Boundaries of care: reflected that appraisal (reflexive monitoring) by ED and stroke teams about their respective boundaries of clinical practice impeded uptake of the protocols. CONCLUSION(S): Despite initial high 'buy-in' from clinicians, a theoretically informed and comprehensive implementation strategy was unable to overcome system and clinician level barriers. Initiatives to drive change and integrate protocols rested largely with senior nurses who had to overcome contextual factors that fell outside their control, including low medical engagement, beliefs about the supporting evidence and perceptions of professional boundaries. To maximise uptake of evidence and adherence to intervention fidelity in complex clinical settings such as ED cost-effective strategies are needed to overcome these barriers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ( ACTRN12614000939695 ).en
dc.languageenen
dc.languageEnglishen
dc.publisherNLM (Medline)en
dc.relation.ispartofImplementation Science: IS-
dc.titleProcess evaluation of an implementation trial to improve the triage, treatment and transfer of stroke patients in emergency departments (T3 trial): a qualitative study.en
dc.typeArticleen
dc.type.studyortrialQualitative study-
dc.identifier.doihttp://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1186/s13012-020-01057-0-
dc.publisher.placeUnited Kingdomen
dc.identifier.pubmedid33148343 [http://www.ncbi.nlm.nih.gov/pubmed/?term=33148343]en
dc.identifier.source633349374en
dc.identifier.institution(McInnes) Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Daniel Mannix Building, Level 4Brunswick Street, VIC 3065, Australia (Dale, Craig, Phillips, Middleton) Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, deLacy Building, Level 5Victoria Street ,Darlinghurst, NSW 2010, Australia (Fasugba) Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 2, Signadou Building, Australian Catholic University, 223 Antill Street, Watson, Australian Capital Territory, 2602, Australia (Schadewaldt) Department of Neurosurgery, University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia (Schadewaldt) Formerly: Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, VIC, Australia (Cheung) Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, NSW, Australia (Cadilhac) Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia (Cadilhac) University of Melbourne, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia (Grimshaw) Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital - General Campus, Centre for Practice-Changing Research (CPCR), Room 1286, 501 Smyth Road, Ottawa, ON K1H 8 L6, Canada (Grimshaw) Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8 M5, Canada (Levi) Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Liverpool, NSW, Australia (Considine) School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia (Considine) Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia (McElduff) School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia (Gerraty) Department of Medicine, Monash University, Melbourne, VIC 3800, Australia (Gerraty) Neurosciences Clinical Institute, Epworth Hospital, Richmond, VIC 3121, Australia (Fitzgerald) Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia (Fitzgerald) Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia (Ward) Nulungu Research Institute, University of Notre Dame Australia, Broome, WA, Australia (D'Este) National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, 0200, Australia (D'Este) School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australiaen
dc.rights.statementThis record is sourced from MEDLINE/PubMed, a database of the U.S. National Library of Medicineen
dc.subect.keywordsAcute stroke Emergency departments Normalisation process theory Process evaluation Qualitative designen
dc.identifier.authoremailMcInnes E.; liz.mcinnes@acu.edu.auen
dc.description.grantNo: 1024812 (2012-2017) Organization: (NHMRC) *National Health and Medical Research Council*en
dc.identifier.affiliationext(McInnes) Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, School of Nursing, Midwifery & Paramedicine, Australian Catholic University, Daniel Mannix Building, Level 4Brunswick Street, VIC 3065, Australia-
dc.identifier.affiliationext(Dale, Craig, Phillips, Middleton) Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, deLacy Building, Level 5Victoria Street ,Darlinghurst, NSW 2010, Australia-
dc.identifier.affiliationext(Fasugba) Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Level 2, Signadou Building, Australian Catholic University, 223 Antill Street, Watson, Australian Capital Territory, 2602, Australia-
dc.identifier.affiliationext(Schadewaldt) Department of Neurosurgery, University of Melbourne and Royal Melbourne Hospital, Grattan Street, Parkville, VIC 3050, Australia-
dc.identifier.affiliationext(Schadewaldt) Formerly: Nursing Research Institute - St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, VIC, Australia-
dc.identifier.affiliationext(Cheung) Centre for Diabetes and Endocrinology Research, Westmead Hospital and University of Sydney, Westmead, Sydney, NSW, Australia-
dc.identifier.affiliationext(Cadilhac) University of Melbourne, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia-
dc.identifier.affiliationext(Grimshaw) Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital - General Campus, Centre for Practice-Changing Research (CPCR), Room 1286, 501 Smyth Road, Ottawa, ON K1H 8 L6, Canada-
dc.identifier.affiliationext(Grimshaw) Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8 M5, Canada-
dc.identifier.affiliationext(Levi) Sydney Partnership for Health Education Research & Enterprise (SPHERE), University of New South Wales, Liverpool, NSW, Australia-
dc.identifier.affiliationext(Considine) School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia-
dc.identifier.affiliationext(Considine) Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia-
dc.identifier.affiliationext(McElduff) School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia-
dc.identifier.affiliationext(Gerraty) Department of Medicine, Monash University, Melbourne, VIC 3800, Australia-
dc.identifier.affiliationext(Gerraty) Neurosciences Clinical Institute, Epworth Hospital, Richmond, VIC 3121, Australia-
dc.identifier.affiliationext(Fitzgerald) Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia-
dc.identifier.affiliationext(Fitzgerald) Faculty of Science, Engineering and Technology, Swinburne University of Technology, Melbourne, Australia-
dc.identifier.affiliationext(Ward) Nulungu Research Institute, University of Notre Dame Australia, Broome, WA, Australia-
dc.identifier.affiliationext(D'Este) National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, 0200, Australia-
dc.identifier.affiliationext(D'Este) School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia-
dc.identifier.affiliationmh(Cadilhac) Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia-
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item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.grantfulltextnone-
item.cerifentitytypePublications-
item.openairetypeArticle-
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