Effectiveness of implementation strategies for the improvement of guideline and protocol adherence in emergency care: A systematic review

Remco H.A. Ebben*, Flaka Siqeca, Ulla Riis Madsen, Lilian C.M. Vloet, Theo Van Achterberg

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

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.

Original languageEnglish
Article numbere017572
JournalBMJ Open
Volume8
Issue number11
Number of pages13
ISSN2044-6055
DOIs
Publication statusPublished - Nov 2018

Keywords

  • emergency medical services
  • emergency medical technicians
  • guideline adherence
  • implementation

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