title: Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study.
abstract: OBJECTIVE
  In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Ministry of Health and Long-Term Care as part of its strategy to reduce emergency department (ED) waiting times. Our objective was to describe general characteristics of the program at each of the participating sites and to examine barriers and facilitators to integrating CDUs into practice.
  
  
  METHODS
  On-site small-group interviews were conducted in two phases with ED and hospital staff at participating sites, first at 8 to 12 weeks and again at 12 months postimplementation. Interview data were analyzed using the framework approach. Unstructured field notes and CDU clinical care protocols and documentation were also reviewed.
  
  
  RESULTS
  The qualitative analysis identified 10 key themes related to integrating CDUs into EDs: shift in clinical and operational practice; administrative aspects of implementation; team building and stakeholder involvement; use of clinical care protocols; physical or virtual model of care; responsive ancillary services; involvement of specialist services; coordination with hospital and community supports; appropriate use of the CDU; and ongoing evaluation and monitoring. Each theme represents an important insight from the perspective of clinical and administrative staff at participating sites.
  
  
  CONCLUSIONS
  The implementation of CDUs is a complex process, with no single preferred clinical care or operational model. This study identifies a number of key considerations relevant to the future implementation of CDUs.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Salkeld
authors.forename: Chad A
authors.initials: CA
authors.lastname: Leaver
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Vermeulen
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Anne
authors.initials: A
authors.lastname: Sales
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Schull
mesh_terms: D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006284:Health Plan Implementation; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D019370:Observation; D009864:Ontario; D010865:Pilot Projects; D036301:Qualitative Research