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Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study

Published online by Cambridge University Press:  11 May 2015

Erin Salkeld ,
Chad A. Leaver ,
Astrid Guttmann ,
Marian J. Vermeulen ,
Brian H. Rowe ,
Anne Sales  and
Michael J. Schull
Erin Salkeld
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON
Chad A. Leaver
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON
Astrid Guttmann
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Department of Paediatrics, University of Toronto, Toronto, ON Division of Paediatric and Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, ON
Marian J. Vermeulen
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, AB School of Public Health, University of Alberta, Edmonton, AB
Anne Sales
Affiliation:
Faculty of Nursing, University of Alberta, Edmonton, AB
Michael J. Schull*
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON
*
Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, ON M4N 3M5; mjs@ices.on.ca

Abstract:

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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.

Conclusion:

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.

Keywords

clinical decision unitemergency servicesevaluationqualitative research
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 6 , November 2011 , pp. 363 - 371
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

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