Implementing Clinical Standards
Implementing Clinical Standards
It is formulated by weighing the risks versus the benefits of the intervention and by considering the patient/family values and preferences, quality of evidence, importance of the outcome, ease of implementation, costs, and resources.
Implementation of clinical standards
Implementation of clinical standards, described here briefly as the context in which guidelines are implemented, is broadly variable and literature for successful uptake specific to the EMSC continuum is limited. With rare exception, the entirety of guidelines or components of the guideline may represent the shared baseline by which a quality improvement (QI) initiative is driven. Nonetheless, opportunities in utilizing improvement methodologies such as the Model for Improvement with its embedded Plan-Do-Study-Act (PDSA) cycles are used at Texas Children’s Hospital (TCH) as the method of choice, although many other methods are also incorporated.33 Iterative improvements are discovered during the planning phase and multiple QI tools are utilized to understand the workflow, leverage points, metrics, and analytics to manage change and drive improvement in outcomes. The Agency for Healthcare Research and Quality suggests that a QI implementation team be comprised of individuals connected to or a part of hospital leadership, clinical experts in the intervention or disease process of focus, persons proficient in QI methodology, and influential personnel from the areas most affected by the change.34 Critical to understanding the financial impact and value of clinical standards is the incorporation of finance team members into our implementation teams.
Factors that influence implementation success of clinical standards have been described and include the following:35-40
Characteristics of the guideline that improve uptake:
a low complexity guideline (ie, easy to understand and use)
the scientific nature of the guideline being evidence-based rather than lacking a scientific basis
development by the target group and stakeholders who will use it
Characteristics of the implementation strategies that improve success:
multifaceted, intensive strategies involving system redesign
Characteristics of professionals that will decrease success:
lack of familiarity or limited familiarity
lack of agreement with the clinical standard
younger age or less experience of the professional
Characteristics of patients that decrease uptake by the user:
patients who perceive no need for guideline recommendations or reject them
patients with comorbidities
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