Skip to main content Accessibility help
×
Home

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

  • Erin Salkeld (a1), Chad A. Leaver (a1), Astrid Guttmann (a1) (a2) (a3) (a4), Marian J. Vermeulen (a1), Brian H. Rowe (a5) (a6), Anne Sales (a7) and Michael J. Schull (a1) (a2) (a8)...

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.

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.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

Corresponding author

Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, G-Wing, Toronto, ON M4N 3M5; mjs@ices.on.ca

References

Hide All
1.Ontario Ministry of Health and Long-Term Care. Understanding emergency room performance. 2009. Available at: http://www.health.gov.on.ca/transformation/length_of_stay/ pro/index.html (accessed January 21, 2010).
2.Vancouver Coastal Health. Innovation reduces ER congestion in Lower Mainland. 2009. Available at: http://www.vch. ca/about_us/news/media_contacts/news_releases/innovation_ reduces_er_congestion_in_lower_mainland (accessed January 21, 2010).
3.Alberta Health Services. Edmonton EMS, Capital Health hopeful changes will improve ambulance access. 2007. Available at: http://www.capitalhealth.ca/NewsAndEvents/NewsReleases/2007/Ambulance_access.htm (accessed January 21, 2010).
4.Bell, R, Willett, J, Oliver, J. Improving access to emergency care: addressing system issues. Toronto: Ontario Hospital Association, Ontario Medical Association, Ontario Ministry of Health and Long-Term Care; 2006.
5.Martinez, E, Reilly, BM, Evans, AT, et al. The observation unit: a new interface between inpatient and outpatient care. Am J Med 2001;110:274–7, doi:10.1016/S0002-9343(00) 00710-5.
6.Roberts, MV, Baird, W, Kerr, P, et al. Can an emergency department-based clinical decision unit successfully utilize alternatives to emergency hospitalization? Eur J Emerg Med 2010;17:8996, doi:10.1097/MEJ.0b013e32832f05bf.
7.Ritchie, J, Spencer, E. Qualitative data analysis for applied policy research. In: Bryman, A, Burgess, RG, editors. Analysing qualitative data. London: Routledge, 1994. p. 173–94.
8.Hassan, TB. Clinical decision units in the emergency department: old concepts, new paradigms, and refined gate keeping. Emerg Med J 2003;20:123–5, doi:10.1136/emj. 20.2.123.
9.Runy, LA. Clinical observation units: building a bridge between outpatient and inpatient services. Hospitals & Health Networks Magazine 2006. Available at: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/2006March/0603HHN_FEA_gatefold&domain=HHNMAG (accessed March 2, 2010).
10.McGowan, A, Hassan, TB. Clinical decision units: a new development for emergency medicine in the United Kingdom. Emerg Med 2003;15:1821, doi: 10.1046/j.1442-2026.2003.00402.x.
11.Brillman, J, Mathers-Dunbar, L, Graff, L, et al. Management of observation units. Ann Emerg Med 1995;25:823–30, doi:10.1016/S0196-0644(95)70215-6.
12.Cooke, MW, Higgins, J, Kidd, P. Use of emergency observation and assessment wards: a systematic literature review. Emerg Med J 2003;20:138–42, doi: 10.1136/ emj.20.2.138.
13.State of Victoria. Observation medicine guidelines 2009. Melbourne: Victorian Government Department of Human Services; 2009.
14.The College of Emergency Medicine. The way ahead 2008–2012: strategy and guidance for emergency medicine in the United Kingdom and the Republic of Ireland. London UK: The College of Emergency Medicine; 2008.
15.Pearson, SD, Goulart-Fisher, D, Lee, TH. Critical pathways as a strategy for improving care: problems and potential. Ann Intern Med 1995;123:941–8.
16.Graff, L. The textbook of observation medicine: The healthcare system’s tincture of time. 2010. Available at: http://www.acep.org/pressroom.aspx?LinkIdentifier=id&id=46142&fid=3496&Mo=No (accessed May 4, 2010).
17.Graff, L, Zun, LS, Leikin, J, et al. Emergency department observation beds improve patient care: Society for Academic Emergency Medicine debate. Ann Emerg Med 1992;21:967–75, doi:10.1016/S0196-0644(05)82937-3.
18.Landers, GA, Waeckerle, JF, McNabey, WK. Observation ward utilization. JACEP 1975;4:123–5.
19.Johnson, WH. Pros and cons of emergency department observation wards. JACEP 1976;5:45.
20.Krome, RL. Observation care units. Ann Emerg Med 1989;18: 705, doi:10.1016/S0196-0644(89)80535-9.

Keywords

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

  • Erin Salkeld (a1), Chad A. Leaver (a1), Astrid Guttmann (a1) (a2) (a3) (a4), Marian J. Vermeulen (a1), Brian H. Rowe (a5) (a6), Anne Sales (a7) and Michael J. Schull (a1) (a2) (a8)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed