title: Factors influencing the implementation of the guideline triage in emergency departments: a qualitative study.
abstract: OBJECTIVE
  The objectives are: (1) to identify factors that influence the implementation of the guideline Triage in emergency departments [2004] in emergency departments in the Netherlands, and (2) to develop tailored implementation strategies for implementation of this guideline.
  
  
  BACKGROUND
  Guideline dissemination is no guarantee for guideline implementation. In 2004 the guideline Triage in Emergency Departments was disseminated in Dutch hospitals. Guideline revision was scheduled in 2008. Prior to the revision, factors which influenced the implementation of the guideline [2004] were studied to be addressed at the implementation of the revised guideline.
  
  
  METHODS
  This is an exploratory study using a qualitative design including: a questionnaire sent to all emergency departments in the Netherlands (n = 108): four focus group interviews, including nurses and ward managers and in-depth interviews with ward managers and doctors. Based on the results, tailored implementation strategies and activities were suggested which target the identified influencing factors.
  
  
  RESULTS
  Various factors at individual, social context and organisational level were identified as influencing the implementation of the 2004 version of the guideline, namely: level of knowledge; insight and skills; work preferences; motivation and/or commitment; support; informed doctors; preliminary work and arrangements for implementation; description of tasks and responsibilities; workload and resources. Ward managers, nurses and doctors mentioned similar as well as different factors. Consequently, tailored implementation strategies and activities related to education, maintenance of change, motivation and consensus-building, information, organisation and facilitation were suggested.
  
  
  CONCLUSIONS
  Nurses, ward managers and doctors broadly indicated similar influencing factors, although the importance of these factors differed for the different groups. For nurses, resistance and lack of resources are most important, ward managers mentioned culture and doctors the availability of doctors at the emergency department.
  
  
  CONCLUSIONS
  Insight into the barriers for implementation and tailoring implementation strategies to these barriers improves the implementation.
authors.affiliation: Faculty of Health and Social Studies, Department of Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands. maaike.janssen@han.nl
authors.forename: Maaike A P
authors.initials: MA
authors.lastname: Janssen
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.forename: Marian J M
authors.initials: MJ
authors.lastname: Adriaansen
authors.forename: Caroline S
authors.initials: CS
authors.lastname: Kampshoff
authors.forename: Donna M J
authors.initials: DM
authors.lastname: Schalk
authors.forename: Joke
authors.initials: J
authors.lastname: Mintjes-de Groot
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D017144:Focus Groups; D017408:Guidelines as Topic; D011795:Surveys and Questionnaires