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Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: a systematic review
HAN Univ Appl Sci, Res Dept Emergency & Crit Care, Fac Hlth & Social Studies, Nijmegen, Netherlands.
Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Acad Ctr Nursing & Midwifery, Leuven, Belgium;Univ Prishtina, Pristina, Kosovo.ORCID iD: 0000-0002-5653-1869
Holbaek Cent Hosp, Holbek, Region Sjaellan, Denmark.
HAN Univ Appl Sci, Res Dept Emergency & Crit Care, Fac Hlth & Social Studies, Nijmegen, Netherlands;Radboud Univ Nijmegen, Med Ctr, IQ Healthcare, Radboud Inst Hlth Sci, Nijmegen, Netherlands.
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2018 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 11, article id e017572Article, review/survey (Refereed) Published
Abstract [en]

Objective Guideline and protocol adherence in prehospital and in-hospital emergency departments (EDs) is suboptimal. Therefore, the objective of this systematic review was to identify effective strategies for improving guideline and protocol adherence in prehospital and ED settings. Design Systematic review. Data sources PubMed (including MEDLINE), CINAHL, EMBASE and Cochrane. Methods We selected (quasi) experimental studies published between 2004 and 2018 that used strategies to increase guideline and protocol adherence in prehospital and in-hospital emergency care. Pairs of two independent reviewers performed the selection process, quality assessment and data extraction. Results Eleven studies were included, nine of which were performed in the ED setting and two studies were performed in a combined prehospital and ED setting. For the ED setting, the studies indicated that educational strategies as sole intervention, and educational strategies in combination with audit and feedback, are probably effective in improving guideline adherence. Sole use of reminders in the ED setting also showed positive effects. The two studies in the combined prehospital and ED setting showed similar results for the sole use of educational interventions. Conclusions Our review does not allow firm conclusion on how to promote guideline and protocol adherence in prehospital emergency care, or the combination of prehospital and ED care. For ED settings, the sole use of reminders or educational interventions and the use of multifaceted strategies of education combined with audit and feedback are all likely to be effective in improving guideline adherence.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018. Vol. 8, no 11, article id e017572
Keywords [en]
emergency medical technicians, emergency medical services, guideline adherence, implementation
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-375610DOI: 10.1136/bmjopen-2017-017572ISI: 000454740400001PubMedID: 30478101OAI: oai:DiVA.org:uu-375610DiVA, id: diva2:1284327
Available from: 2019-01-31 Created: 2019-01-31 Last updated: 2019-01-31Bibliographically approved

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