A Healthcare Improvement Initiative to Increase Multidisciplinary Pain Management Referrals for Youth with Sickle Cell Disease

The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review

OBJECTIVES

Quality Improvement (QI) and Implementation Science (IS) are both frequently utilised in health research. Little is known about how they are integrated within studies, and whether combined they add value. This systematic review sought to investigate how QI and IS theories and strategies are integrated within healthcare-based studies.

METHODS

A systematic search was conducted across five databases. Duplicates, studies published prior to 2014, systematic and scoping reviews, and study protocols were removed. The retrieved title abstracts were screened, and the full texts of eligible studies were reviewed in pairs using Covidence software. Of the included studies, data were extracted using a predefined template, and studies were critically appraised using the QI Minimum Quality Criteria Set. Frequency analysis of the use of QI or IS tools was conducted, as well as a narrative analysis of the integration of QI and IS in each study.

RESULTS

The database search returned 3,407 title abstracts, of which 1,618 were screened. Assessment for eligibility resulted in the identification of 149 studies, of which the full texts were reviewed, and 12 studies included in the final analysis. These 12 studies integrated QI and IS methods to implement an intervention in tertiary healthcare. The Plan-Do-Study-Act (PDSA) cycle was the most frequently used QI tool and the Theoretical Domains Framework, Behaviour Change Wheel (including Capabilities, Opportunity and Motivation) and the Consolidated Framework for Implementation Research were the most frequently used IS frameworks.

CONCLUSION

The study highlights a lack of consistent terminology across the QI and IS fields, as well as opportunities for greater integration of the two fields to enhance study design, implementation and sustainability, and to improve healthcare performance.

The Role of Nurses Caring for Children Diagnosed with Sickle Cell Anemia and Their Families in a Hospital Setting: A Rapid Review of the Recent Literature

Background: Sickle cell anemia (SCA) affects a significant number of children worldwide, for whom the progression of the disease can lead to functional disability-impaired development. Nurses are pivotal in providing holistic care to these children and their families. This review aims to identify recent evidence on the role of nurses in intervening with children with SCA and their families in a hospital setting. Methods: A rapid review reported under the PRISMA methodology was carried out in the CINAHL, MEDLINE, and Scopus databases with the expression (sickle cell anemia OR sickle cell disease) AND (child* OR family OR pediatric*) AND (nurs* OR "nursing interventions" OR "pediatric nursing") AND (hospital*), considering studies between 2019 and 2024, written in English, identifying articles with insights about the role of nurses in this context. Articles other than primary or secondary studies were excluded. Data were analyzed through a rapid qualitative approach. Results: Fifty-two studies were identified and seventeen articles were included. The nurse's role is key and multidisciplinary, focusing on the child and family (care management and therapeutic education), the team (training, and the promotion of safety and quality of care), and the health system (optimizing access to care and promoting adequate resources for its implementation). Such a role is important for short-term clinical problems and to prevent long-term complications. Conclusions: Nurses play a central role in empowering families and coordinating multidisciplinary care. Greater investment is needed at a clinical level, through a more effective response to the needs of these patients, and in research, through experimental studies and other designs focused on multidisciplinary interventions.

Beyond Plan-Do-Study-Act cycle - staff perceptions on facilitators and barriers to the implementation of telepresence robots in long-term care

BACKGROUND

Quality improvement (QI) programs with technology implementations have been introduced to long-term care (LTC) to improve residents' quality of life. Plan-Do-Study-Act (PDSA) cycle is commonly adopted in QI projects. There should be an appropriate investment of resources to enhance learning from iterative PDSA cycles. Recently, scholars explored possibilities of implementation science (IS) with QI methods to increase QI projects' generalisability and make them more widely applicable in other healthcare contexts. To date, scant examples demonstrate the complementary use of the two methods in QI projects involving technology implementation. This qualitative study explores staff and leadership teams' perspectives on facilitators and barriers of a QI project to implement telepresence robots in LTC guided by the Consolidated Framework for Implementation Research (CFIR).

METHODS

We employed purposive and snowballing methods to recruit 22 participants from two LTC in British Columbia, Canada: operational and unit leaders and interdisciplinary staff, including nursing staff, care aides, and allied health practitioners. CFIR was used to guide data collection and analysis. Semi-structured interviews and focus groups were conducted through in-person and virtual meetings. Thematic analysis was employed to generate insights into participants' perspectives.

RESULTS

Our analysis identified three themes: (a) The essential needs for family-resident connections, (b) Meaningful engagement builds partnership, and (c) Training and timely support gives confidence. Based on the findings and CFIR guidance, we demonstrate how to plan strategies in upcoming PDSA cycles and offer an easy-to-use tool 'START' to encourage the practical application of evidence-based strategies in technology implementation: Share benefits and failures; Tailor planning with staff partners; Acknowledge staff concerns; Recruit opinion leaders early; and Target residents' needs.

CONCLUSIONS

Our study offers pragmatic insights into the complementary application of CFIR with PDSA methods in QI projects on implementing technologies in LTC. Healthcare leaders should consider evidence-based strategies in implementing innovations beyond PDSA cycles.

Implementation science in adolescent healthcare research: an integrative review

Background

Multiple theories, models and frameworks have been developed to assist implementation of evidence-based practice. However, to date there has been no review of implementation literature specific to adolescent healthcare. This integrative review therefore aimed to determine what implementation science theories, models and frameworks have been applied, what elements of these frameworks have been identified as influential in promoting the implementation and sustainability of service intervention, and to what extent, in what capacity and at what time points has the contribution of adolescent consumer perspectives on evidence implementation been considered. 

Methods

An integrative design was used and reported based on a modified form of the PRISMA (2020) checklist. Seven databases were searched for English language primary research which included any implementation science theory, model or framework developed for/with adolescents or applied in relation to adolescent healthcare services within the past 10 years. Content and thematic analysis were applied with the Consolidated Framework for Implementation Research (CFIR) used to frame analysis of the barriers and facilitators to effective implementation of evidence-informed interventions within youth health settings.

Results

From 8717 citations, 13 papers reporting 12 studies were retained. Nine different implementation science theories, frameworks or approaches were applied; six of 12 studies used the CFIR, solely or with other models. All CFIR domains were represented as facilitators and barriers for implementation in included studies. However, there was little or no inclusion of adolescents in the development or review of these initiatives. Only three mentioned youth input, occurring in the pre-implementation or implementation stages.

Conclusions

The few studies found for this review highlight the internationally under-developed nature of this topic. Flagging the importance of the unique characteristics of this particular age group, and of the interventions and strategies to target it, the minimal input of adolescent consumers is cause for concern. Further research is clearly needed and must ensure that youth consumers are engaged from the start and consistently throughout; that their voice is prioritised and not tokenistic; that their contribution is taken seriously. Only then will age-appropriate evidence implementation enable innovations in youth health services to achieve the evidence-based outcomes they offer.

Trial Registration

PROSPERO 2020 CRD42020201142 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201142

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07941-3.