Lessons learned in implementing SCI clinical practice guidelines.
While clinical practice guidelines (CPGs) were designed as a tool to improve patient outcomes, decrease practice variation, and optimize resource utilization, providers often encounter significant barriers to integrating these into clinical practice. A study was conducted at six spinal cord injury (SCI) centers in the Department of Veterans Affairs (VA) to improve provider adherence and patient outcomes of two CPGs: Prevention of Thromboembolism in Spinal Cord Injury and Neurogenic Bowel Management in Adults With Spinal Cord Injury. To design effective implementation strategies, focus groups were conducted to identify provider-perceived barriers and facilitators to implementing recommendations for each of the SCI guidelines. Based on this information, four guideline implementation strategies were designed: (a) use of local opinion leaders ("clinical champions"), (b) patient-mediated interventions, (c) standardized documentation template/standing orders, and (d) social marketing/outreach visits. These strategies were implemented at each site. This article identifies "lessons learned" during the process of trying to get these CPGs embedded into clinical practice.
Guihan
Maylou
M
Midwest Center for Health Services and Policy Research, Edward Hines Jr VA Hospital, Illinois, USA.
Bosshart
Helen T
HT
Nelson
Audrey
A
D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004282:Documentation; D019317:Evidence-Based Medicine; D017144:Focus Groups; D019983:Guideline Adherence / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007857:Leadership; D008389:Marketing of Health Services; D020380:Needs Assessment; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D017410:Practice Guidelines as Topic; D013119:Spinal Cord Injuries / Q000150:complications*; D011795:Surveys and Questionnaires; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000517:prevention & control*; D014728:Veterans