Process evaluation of the T3 trial: A nurse-initiated intervention to improve stroke care in the emergency department.

Abstract

Background and Purpose: A cluster randomised controlled trial was undertaken to evaluate a theory-informed, nurse-initiated protocol-based intervention to improve multidisciplinary Triage, Treatment and Transfer of Patients with acute stroke in emergency departments (EDs): The T3 Trial. The aim of the process evaluation was to understand the extent to which intervention sites integrated the T3 clinical protocols into practice and to identify contextual factors that may have influenced uptake and adoption of the protocols. Method(s): Descriptive qualitative study design using face-to-face semi-structured interviews. Purposive sampling was used to select ED clinicians from two high and two low performing intervention sites. Eligible participants were as follows: Medical Directors, Nurse Unit Mangers, bedside nurses and clinical champions. Participants were interviewed about their views on barriers and facilitators to implementation. Data were analysed thematically. Result(s): Twenty-five interviews were completed. Three major themes were: the dynamics of change, protocol fidelity and care trajectory. Dynamics of change represents the challenges of achieving implementation in a context of high staff turnover; Fidelity to the protocol represents the impact of organisational factors on intervention fidelity, and Care Trajectory represents the availability of resources along the patient pathway that impact on whether elements of the protocols were delivered. ImplicationsImplementing an intervention in the busy and complex setting of the ED can compromise the delivery of evidence-based care protocols. Factors that affect delivery including resources, staff turnover and workplace context require addressing to ensure success implementation.