TY - JOUR
T1 - A qualitative study exploring factors associated with provider adherence to severe pediatric traumatic brain injury guidelines
AU - Brolliar, Sarah M.
AU - Moore, Megan
AU - Thompson, Hilaire J.
AU - Whiteside, Lauren K.
AU - Mink, Richard B.
AU - Wainwright, Mark S.
AU - Groner, Jonathan I.
AU - Bell, Michael J.
AU - Giza, Christopher C.
AU - Zatzick, Douglas F.
AU - Ellenbogen, Richard G.
AU - Ng Boyle, Linda
AU - Mitchell, Pamela H.
AU - Rivara, Frederick P.
AU - Vavilala, Monica S.
N1 - Funding Information:
This study was provided by National Institute of Neurological Disorders and Stroke grant R01 NS072308-03 (Vavilala) and National Center for Advancing Translational Sciences grant KL2TR000421 (Moore).
Publisher Copyright:
Copyright © 2016, Mary Ann Liebert, Inc.
PY - 2016/8/15
Y1 - 2016/8/15
N2 - Despite demonstrated improvement in patient outcomes with use of the Pediatric Traumatic Brain Injury (TBI) Guidelines (Guidelines), there are differential rates of adherence. Provider perspectives on barriers and facilitators to adherence have not been elucidated. This study aimed to identify and explore in depth the provider perspective on factors associated with adherence to the Guidelines using 19 focus groups with nurses and physicians who provided acute management for pediatric patients with TBI at five university-affiliated Level 1 trauma centers. Data were examined using deductive and inductive content analysis. Results indicated that three inter-related domains were associated with clinical adherence: 1) perceived guideline credibility and applicability to individual patients, 2) implementation, dissemination, and enforcement strategies, and 3) provider culture, communication styles, and attitudes towards protocols. Specifically, Guideline usefulness was determined by the perceived relevance to the individual patient given age, injury etiology, and severity and the strength of the evidence. Institutional methods to formally endorse, codify, and implement the Guidelines into the local culture were important. Providers wanted local protocols developed using interdisciplinary consensus. Finally, a culture of collaboration, including consistent, respectful communication and interdisciplinary cooperation, facilitated adherence. Provider training and experience, as well as attitudes towards other standardized care protocols, mirror the use and attitudes towards the Guidelines. Adherence was determined by the interaction of each of these guideline, institutional, and provider factors acting in concert. Incorporating provider perspectives on barriers and facilitators to adherence into hospital and team protocols is an important step toward improving adherence and ultimately patient outcomes.
AB - Despite demonstrated improvement in patient outcomes with use of the Pediatric Traumatic Brain Injury (TBI) Guidelines (Guidelines), there are differential rates of adherence. Provider perspectives on barriers and facilitators to adherence have not been elucidated. This study aimed to identify and explore in depth the provider perspective on factors associated with adherence to the Guidelines using 19 focus groups with nurses and physicians who provided acute management for pediatric patients with TBI at five university-affiliated Level 1 trauma centers. Data were examined using deductive and inductive content analysis. Results indicated that three inter-related domains were associated with clinical adherence: 1) perceived guideline credibility and applicability to individual patients, 2) implementation, dissemination, and enforcement strategies, and 3) provider culture, communication styles, and attitudes towards protocols. Specifically, Guideline usefulness was determined by the perceived relevance to the individual patient given age, injury etiology, and severity and the strength of the evidence. Institutional methods to formally endorse, codify, and implement the Guidelines into the local culture were important. Providers wanted local protocols developed using interdisciplinary consensus. Finally, a culture of collaboration, including consistent, respectful communication and interdisciplinary cooperation, facilitated adherence. Provider training and experience, as well as attitudes towards other standardized care protocols, mirror the use and attitudes towards the Guidelines. Adherence was determined by the interaction of each of these guideline, institutional, and provider factors acting in concert. Incorporating provider perspectives on barriers and facilitators to adherence into hospital and team protocols is an important step toward improving adherence and ultimately patient outcomes.
KW - brain injury
KW - evidence-based medicine
KW - guideline adherence
KW - injury
KW - pediatrics
KW - trauma
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U2 - 10.1089/neu.2015.4183
DO - 10.1089/neu.2015.4183
M3 - Article
C2 - 26760283
AN - SCOPUS:84983621566
SN - 0897-7151
VL - 33
SP - 1554
EP - 1560
JO - Journal of neurotrauma
JF - Journal of neurotrauma
IS - 16
ER -