Barriers and enablers to the implementation of a complex quality improvement intervention for acute kidney injury: A qualitative evaluation of stakeholder perceptions of the Tackling AKI study

English version

Autoři: Laura Lamming ^aff001; Eileen McDonach ^aff001; Mohammed A. Mohammed ^aff001; John Stoves ^aff002; Andy J. Lewington ^aff003; Russell Roberts ^aff002; Yohan Samarasinghe ^aff006; Nikunj Shah ^aff007; Richard J. Fluck ^aff008; Natalie Jackson ^aff009; Melanie Johnson ^aff009; Carol Jones ^aff007; Nicholas M. Selby ^aff008
Působiště autorů: Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, United Kingdom ^aff001; Bradford Teaching Hospitals NHS Foundation Trust, Bradford, West Yorkshire, United Kingdom ^aff002; Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom ^aff003; The NIHR Leeds In Vitro Diagnostics Co-operative, Leeds, West Yorkshire, United Kingdom ^aff004; Bradford Institute for Health Research, Bradford, West Yorkshire, United Kingdom ^aff005; Frimley Health NHS Foundation Trust, Frimley, United Kingdom ^aff006; Ashford and St Peter’s NHS Foundation Trust, Surrey, United Kingdom ^aff007; Department of Renal Medicine, Derby Teaching Hospitals NHS Foundation Trust, Derby, United Kingdom ^aff008; Yorkshire & Humber AHSN improvement academy, Bradford Institute for Health Research, Bradford, West Yorkshire, United Kingdom ^aff009; Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Derby Teaching Hospitals NHS Foundation Trust, Derby, United Kingdom ^aff010
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222444

Souhrn

Background

Acute kidney injury in hospital patients is common and associated with reduced survival and higher healthcare costs. The Tackling Acute Kidney Injury (TAKI) quality improvement project aimed to reduce mortality rates in patients with acute kidney injury by implementing a multicomponent intervention comprising of an electronic alert, care bundle and education in five UK hospitals across a variety of wards. A parallel developmental evaluation using a case study approach was conducted to provide the implementation teams with insights into factors that might impact intervention implementation and fidelity. The qualitative element of the evaluation will be reported.

Methods

29 semi-structured interviews with implementation teams across the five hospitals were carried out to identify perceived barriers and enablers to implementation. Interviews were taped and transcribed verbatim and Framework analysis was conducted.

Results

Interviews generated four ‘barriers and enablers’ to implementation themes: i) practical/contextual factors, ii) skills and make-up of the TAKI implementation team, iii) design, development and implementation approach, iv) staff knowledge, attitudes, behaviours and support. Enablers included availability of specialist teams (e.g. educational teams), multi-disciplinary implementation teams with strong leadership, team-based package completion and proactive staff. Barriers were frequently the converse of facilitators.

Conclusions

Despite diversity of sites, a range of common local factors–contextual, intervention-based and individual–were identified as potential barriers and enablers to fidelity, including intervention structure/design and process of/approach to implementation. Future efforts should focus on early identification and management of barriers and tailored optimisation of known enablers such as leadership and multidisciplinary teams to encourage buy-in. Improved measures of real-time intervention and implementation fidelity would further assist local teams to target their support during such quality improvement initiatives.

Klíčová slova:

Biology and life sciences – People and places – Population groupings – Professions – Population biology – Anatomy – Medicine and health sciences – Population metrics – Death rates – Health care – Health care facilities – Hospitals – Health care providers – Medical doctors – Nurses – Patients – Medical personnel – Geriatrics – Renal system – Kidneys – Pharmacists

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