title: Facilitators and barriers to application of the Canadian C-spine rule by emergency department triage nurses.
abstract: OBJECTIVE
  We recently conducted a multicentre implementation study on the use of the Canadian C-Spine Rule (CCR) by emergency department (ED) nurses to clear the c-spine in alert and stable trauma patients (n = 4506). The objective of this study was to conduct a survey of nurses, physicians, and administrators to evaluate their views on the facilitators and barriers to the implementation of the CCR.
  
  
  METHODS
  We conducted both a paper-based and an electronic survey of the three different ED hospital staff groups of nine large teaching hospitals in Ontario, including six regional trauma centres. The content of this survey was informed by a qualitative evaluation of the opinions of the study nurses who had participated in the validation study.
  
  
  RESULTS
  57.5% (281/489) ED triage nurses, 50.2% ED physicians, and 82.8% of administrators responded. Nurse responses most often showed support from manager/educators and teamwork between physicians, nurses, and managers as being important facilitators to the use of the CCR. Physician responses most often identified the importance of a nurse leader/champion/educator, and presence of strong physician leaders. Administrator responses indicated the importance of nurse educators/champions, nurse engagement, and educational support. Barriers indicated by all three groups included busy department, lack of physician support, and lack of nursing support.
  
  
  CONCLUSIONS
  Bringing about change in clinical practice is complex. Strong leadership, effective communication, and senior physician buy-in appear to be very important. Identification of system-specific barriers and facilitators are important components of successful knowledge translation.
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. Electronic address: cclement@ohri.ca.
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Clement
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lowe
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Brehaut
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Calder
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Vaillancourt
authors.affiliation: The Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Perry
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002574:Cervical Vertebrae / Q000293:injuries*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology / Q000592:standards; D009864:Ontario; D014218:Triage / Q000379:methods; D000078329:Workforce
keywords: Cervical spine injury; Clinical decision rule; Emergency department; Implementation; Knowledge translation; Nursing