title: Implementation evaluation and refinement of an intervention to improve blunt chest injury management-A mixed-methods study.
abstract: OBJECTIVE
  To investigate uptake of a Chest Injury Protocol (ChIP), examine factors influencing its implementation and identify interventions for promoting its use.
  
  
  BACKGROUND
  Failure to treat blunt chest injuries in a timely manner with sufficient analgesia, physiotherapy and respiratory support, can lead to complications such as pneumonia and respiratory failure and/or death.
  
  
  METHODS
  This is a mixed-methods implementation evaluation study.
  
  
  METHODS
  Two methods were used: (i) identification and review of the characteristics of all patients eligible for the ChIP protocol, and (ii) survey of hospital staff opinions mapped to the Theoretical Domains Framework (TDF) to identify barriers and facilitators to implementation. The characteristics and treatment received between the groups were compared using the chi-square test or Fischer's exact test for proportions, and the Mann-Whitney U-test for continuous data. Quantitative survey data were analysed using descriptive statistics. Qualitative data were coded in NVivo 10 using a coding guide based on the TDF and Behaviour Change Wheel (BCW). Identification of interventions to change target behaviours was sourced from the Behaviour Change Technique Taxonomy Version 1 in consultation with stakeholders.
  
  
  RESULTS
  Only 68.4% of eligible patients received ChIP. Fifteen facilitators and 10 barriers were identified to influence the implementation of ChIP in the clinical setting. These themes were mapped to 10 of the 14 TDF domains and corresponded with all nine intervention functions in the BCW. Seven of these intervention functions were selected to address the target behaviours and a multi-faceted relaunch of the revised protocol developed. Following re-launch, uptake increased to 91%.
  
  
  CONCLUSIONS
  This study demonstrated how the BCW may be used to revise and improve a clinical protocol in the ED context.
  
  
  CONCLUSIONS
  Newly implemented clinical protocols should incorporate clinician behaviour change assessment, strategy and interventions. Enhancing the self-efficacy of emergency nurses when performing assessments has the potential to improve patient outcomes and should be included in implementation strategy.
authors.affiliation: Sydney Nursing School, The University of Sydney, Camperdown, NSW, Australia.|Trauma Service, St George Hospital, Kogarah, NSW, Australia.|The George Institute for Global Health, Sydney, NSW, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
authors.affiliation: Sydney Nursing School, The University of Sydney, Camperdown, NSW, Australia.
authors.forename: Connie
authors.initials: C
authors.lastname: Van
authors.affiliation: Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Lam
authors.affiliation: St George Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.|Department of Emergency Medicine, St George Hospital, Kogarah, NSW, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Asha
authors.affiliation: St George Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
authors.forename: Annalise
authors.initials: A
authors.lastname: Unsworth
authors.affiliation: Department of Emergency Medicine, St George Hospital, Kogarah, NSW, Australia.
authors.forename: Alana
authors.initials: A
authors.lastname: Clements
authors.affiliation: Centre for Behaviour Change, University College London, London, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Atkins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy; D002985:Clinical Protocols / Q000592:standards*; D006801:Humans; D008297:Male; D024802:Nurse's Role; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013898:Thoracic Injuries / Q000175:diagnosis / Q000628:therapy*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*
keywords: behaviour change; behaviour change wheel; chest injury; implementation evaluation; nursing; theoretical domains framework