Implementation evaluation and refinement of an intervention to improve blunt chest injury management-A mixed-methods study.
Kate Curtis, Connie Van, Mary Lam and 4 others
PMID 28252839WHAT IT FOUND
Only 290 of 424 eligible blunt chest injury patients received the early protocol.
Those who did were more likely to receive several protocol care components. Staff barriers included complexity and after-hours response. Post-relaunch monitoring reported uptake rising to 91%.
Key findings
01Only 290 of 424 eligible patients received a ChIP activation.
02Patients who received a ChIP call were compared on pain team review, physiotherapy review, trauma team review, patient-controlled analgesia and high-flow nasal prong oxygen; they were more likely to have pain team review, trauma team review and high-flow nasal prong oxygen.
03A staff survey of 99 respondents identified 25 themes, 15 facilitators and 10 barriers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
It was done at one hospital, so it may not apply to other services. It looked at whether care components were delivered, not whether patients had fewer complications, and no adjusted analyses were performed. Staff responses came from 99 volunteers, so they may not represent all staff. The choice of behaviour change techniques was limited to a core group and subject to interpretation. The later increase to 91% came from monitoring after relaunch, not a controlled comparison.
Declared interests
The paper states all authors report no conflict of interest. No funding source is reported.
The easy way to misread this
Do not read the 91% uptake after relaunch as proof the revised protocol improves patient outcomes. This paper evaluated implementation and staff behaviour, not adjusted clinical outcomes. ChIP contains several components that cannot be separated.