Browsing by Author "Johnson, David"

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    A Multifaceted Educational Intervention to Increase Uptake of a Urinary Tract Infection Guideline
    (2016-01-22) Banks, Anke Marie; McLaughlin, Kevin; Samuel, Susan; Johnson, David; Hecker, Kent
    Physicians often fail to implement clinical practice guidelines. Our objective was to evaluate whether a multifaceted educational intervention would increase adherence to the American Academy of Pediatrics guideline regarding voiding cystourethrogram (VCUG) use in young children with a first febrile urinary tract infection. We conducted a prospective interventional study at one centre using a pretest-posttest design. We used a health promotion model to construct a multifaceted intervention that included an interactive lecture, clinical pathway and faxed reminder. Over the study period, pediatricians and non-pediatricians ordered a significantly greater monthly proportion of adherent VCUGs. There was a significant decrease in the pediatrician monthly ordering rate of VCUGs. Utilizing logistic regression, the odds of adherence to the guideline were significantly greater among pediatricians than non-pediatricians. In conclusion, following a multifaceted educational intervention, pediatricians were more likely to adhere to the VCUG guideline recommendation than prior to the intervention and than non-pediatricians.
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    Defining barriers and enablers for clinical pathway implementation in complex clinical settings
    (2018-11-12) Jabbour, Mona; Newton, Amanda S; Johnson, David; Curran, Janet A
    Abstract Background While clinical pathways have the potential to improve patient outcomes and reduce healthcare costs, their true impact has been limited by variable implementation strategies and suboptimal research designs. This paper explores a comprehensive set of factors perceived by emergency department staff and administrative leads to influence clinical pathway implementation within the complex and dynamic environments of community emergency department settings. Methods This descriptive, qualitative study involved emergency health professionals and administrators of 15 community hospitals across Ontario, Canada. As part of our larger cluster randomized controlled trial, each site was in the preparation phase to implement one of two clinical pathways: pediatric asthma or pediatric vomiting and diarrhea. Data were collected from three sources: (i) a mediated group discussion with site champions during the project launch meeting; (ii) a semi-structured site visit of each emergency department; and (iii) key informant interviews with an administrative lead from each hospital. The Theoretical Domains Framework (TDF) was used to guide the interviews and thematically analyze the data. Domains within each major theme were then mapped onto the COM-B model—capability, opportunity, and motivation—of the Behaviour Change Wheel. Results Seven discrete themes and 58 subthemes were identified that comprised a set of barriers and enablers relevant to the planned clinical pathway implementation. Within two themes, three distinct levels of impact emerged, namely (i) the individual health professional, (ii) the emergency department team, and (iii) the broader hospital context. The TDF domains occurring most frequently were Memory, Attention and Decision Processes, Environmental Context and Resources, Behavioural Regulation, and Reinforcement. Mapping these barriers and enablers onto the COM-B model provided an organized perspective on how these issues may be interacting. Several factors were viewed as both negative and positive across different perspectives. Two of the seven themes were limited to one component, while four involved all three components of the COM-B model. Conclusions Using a theory-based approach ensured systematic and comprehensive identification of relevant barriers and enablers to clinical pathway implementation in ED settings. The COM-B system of the Behaviour Change Wheel provided a useful perspective on how these factors might interact to effect change. Trial registration ClinicalTrials.gov, NCT01815710 .
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    Implementing evidence-based practices in the care of infants with bronchiolitis in Australasian acute care settings: study protocol for a cluster randomised controlled study
    (2018-07-06) Haskell, Libby; Tavender, Emma J; Wilson, Catherine; O’Brien, Sharon; Babl, Franz E; Borland, Meredith L; Cotterell, Liz; Schuster, Tibor; Orsini, Francesca; Sheridan, Nicolette; Johnson, David; Oakley, Ed; Dalziel, Stuart R
    Abstract Background Bronchiolitis is the most common reason for admission to hospital for infants less than one year of age. Although management is well defined, there is substantial variation in practice, with infants receiving ineffective therapies or management. This study will test the effectiveness of tailored, theory informed knowledge translation (KT) interventions to decrease the use of five clinical therapies or management processes known to be of no benefit, compared to usual dissemination practices in infants with bronchiolitis. The primary objective is to establish whether the KT interventions are effective in increasing compliance to five evidence based recommendations in the first 24 h following presentation to hospital. The five recommendations are that infants do not receive; salbutamol, antibiotics, glucocorticoids, adrenaline, or a chest x-ray. Methods/design This study is designed as a cluster randomised controlled trial. We will recruit 24 hospitals in Australia and New Zealand, stratified by country and provision of tertiary or secondary paediatric care. Hospitals will be randomised to either control or intervention groups. Control hospitals will receive a copy of the recent Australasian Bronchiolitis Guideline. Intervention hospitals will receive KT interventions informed by a qualitative analysis of factors influencing clinician care of infants with bronchiolitis. Key interventions include, local stakeholder meetings, identifying medical and nursing clinical leads in both emergency departments and paediatric inpatient areas who will attend a single education train-the-trainer day to then deliver standardised staff education with the training materials provided and coordinate audit and feedback reports locally over the study period. Data will be extracted retrospectively for three years prior to the study intervention year, and for seven months of the study intervention year bronchiolitis season following intervention delivery to determine compliance with the five evidence-based recommendations. Data will be collected to assess fidelity to the implementation strategies and to facilitate an economic evaluation. Discussion This study will contribute to the body of knowledge to determine the effectiveness of tailored, theory informed interventions in acute care paediatric settings, with the aim of reducing the evidence to practice gaps in the care of infants with bronchiolitis. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616001567415 (retrospectively registered on 14 November 2016).
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    Quality Indicators for the Assessment and Management of Pain in the Emergency Department: A Systematic Review
    (2014-01-01) Stang, Antonia S; Hartling, Lisa; Fera, Cassandra; Johnson, David; Ali, Samina
    BACKGROUND: Evidence indicates that pain is undertreated in the emergency department (ED). The first step in improving the pain experience for ED patients is to accurately and systematically assess the actual care being provided. Identifying gaps in the assessment and treatment of pain and improving patient outcomes requires relevant, evidence-based performance measures.OBJECTIVE: To systematically review the literature and identify quality indicators specific to the assessment and management of pain in the ED.METHODS: Four major bibliographical databases were searched from January 1980 to December 2010, and relevant journals and conference proceedings were manually searched. Original research that described the development or collection of data on one or more quality indicators relevant to the assessment or management of pain in the ED was included.RESULTS: The search identified 18,078 citations. Twenty-three articles were included: 15 observational (cohort) studies; three before-after studies; three audits; one quality indicator development study; and one survey. Methodological quality was moderate, with weaknesses in the reporting of study design and methodology. Twenty unique indicators were identified, with the majority (16 of 20) measuring care processes. Overall, 91% (21 of 23) of the studies reported indicators for the assessment or management of presenting pain, as opposed to procedural pain. Three of the studies included children; however, none of the indicators were developed specifically for a pediatric population.CONCLUSION: Gaps in the existing literature include a lack of measures reflecting procedural pain, patient outcomes and the pediatric population. Future efforts should focus on developing indicators specific to these key areas.
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    The Determinants of Childhood Injury
    (2014-07-21) Victorino, Charlemaigne; Gauthier, Anne; Johnson, David
    Unintentional injuries is an important health concern among children in that it is a major cause of hospitalizations and disability in North America, and is the leading cause of death for children in Canada. This is in light of the fact that a majority of unintentional injuries can be avoided. The current literature looking at predictors of unintentional non-fatal injuries has produced mixed findings. This dissertation examines this important topic using large, nationally representative Canadian and American datasets using a social determinants of health framework. The social determinants of health framework allows one to examine a behaviour or outcome in a more holistic manner, therefore getting closer to uncovering the “root” causes of an outcome, as medical sociologists describe it. Focusing on unintentional injuries occurring in/around the home or in a non-recreation/school setting, this topic was analyzed cross-sectionally, longitudinally, and in a cross-national comparison between Canada and the U.S. Cross-sectionally, the key finding was surprisingly a lack of statistically significant findings. One possible reason for this is the cross-sectional nature of the analysis, in that the influence of variables such as family structure may be more relevant when examined longitudinally i.e. as changes over time. Longitudinally, the key finding was that a change in mixed family structure had a significant and independent association with the occurrence of child injury, even after controlling for factors such as employment status and household income. In the cross-national comparison between Canada and the U.S., there was evidence supporting the notion that a country which has a greater emphasis on policies of economic equality (such as Canada), is less likely to see major differences in the occurrence of adverse child health outcomes between differing socio-economic groups. While unintentional injuries among children has an element of randomness, they are nevertheless still related to social factors including family structure and neighbourhood income, particularly among young children. Due to the importance of injuries to children's health, it is essential to use the information from studies such as this when creating and putting in practice injury prevent programs and policies.
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    “What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework
    (2021-02-05) Ly, Anh; Zemek, Roger; Wright, Bruce; Zwicker, Jennifer; Schneider, Kathryn; Mikrogianakis, Angelo; Conradi, Alf; Johnson, David; Clark, Brenda; Barlow, Karen; Burey, Joseph; Kolstad, Ash; Yeates, Keith O
    Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.