Knowledge Translation Recommendations

CAEP 2017 Academic Symposium on Research: Knowledge Translation Recommendations

In Infographics, Medical Concepts by Brent Thoma1 Comment

As part of the 2017 Canadian Association of Emergency Physicians (CAEP) Conference an Academic Symposium was held on research. One aspect of this symposium investigated best practices for knowledge translation in the emergency department. The 10 recommendations presented in the above infographic and following below were compiled using the preliminary results of a systematic review that was conducted on this topic along with the results of a national survey of emergency physicians. In addition to seeking the input of the symposium participants, we hope to receive additional feedback from the virtual community of emergency physicians and practitioners online. We would appreciate your feedback. All responses will be analyzed and incorporated to improve the final recommendations.

Provide feedback on the recommendations!

10 Recommendations for Knowledge Translation in the ED

  1. Physician practice change is most readily achieved if ED physicians, as a collective group, are the ones who agree on the evidence they are willing to implement and set a group target to achieve.
  2. Beware of evidence that is not ready for implementation; keep your radar up for the recommendation cart placed ahead of the evidence horse.
  3. It is important to choose a clinical problem that has both high certainty in the evidence and a known gap in clinical practice when designing practice changing interventions.
  4. Develop implementation strategies with facilitators that address local barriers, much like a key fits a lock.
  5. Effective practice change interventions in the ED setting may include institutional support, local champions, standardized order sets, education, audit and feedback.
  6. A team based approach to developing, integrating and supporting an implementation strategy is the key to success. Involve all relevant stakeholders – including physicians, nurses, patients, administrators, and allied health care providers.
  7. Plan ahead to measure the impact of the implementation strategy (both compliance with the implementation strategy and relevant patient oriented outcomes). When possible, also monitor for unanticipated consequences.
  8. To ensure success and sustainability, plan for adequate resourcing from the start by incorporating the implementation strategy into the business plan and relevant job descriptions, roles and responsibilities.
  9. ED implementation trials should be rigorously designed, including a thorough assessment of individual provider, patient and system level barriers prior to designing and implementing the intervention.
  10. Protocols of ED implementation trials should be registered, outlining the rationale for intervention components and assumptions about how the implementation strategy will work.

In addition to compiling the listed recommendations, a list of resources for emergency physicians embarking upon knowledge translation initiatives was developed.

Articles and Books

Book

  • Strauss S, Tetroe J, Graham M. Knowledge Translation in Health Care: Moving from Evidence to PracticeJohn Wiley and Sons, 2013.

General Knowledge Translation Articles

  • Bhattacharyya OK, Estey EA, Zwarenstein M. Methodologies to evaluate the effectiveness of knowledge translation interventions: a primer for researchers and health care managers. J Clin Epi 2011; 64:32.
  • Kaster M. Methodologies to evaluate the effectiveness of knowledge translation interventions. Allergy, Asthma & Clinical Immunology 2010;6:A11.
  • Presseau J, Grimshaw JM, Tetroe JM, Eccles MP, Francis JJ, Godin G, Graham ID, Hux JE, Johnston M, Légaré F, Lemyre L, Robinson N, Zwarenstein M. A theory-based process evaluation alongside a randomised controlled trial of printed educational messages to increase primary care physicians’ prescription of thiazide diuretics for hypertension. Implement Sci. 2016; 11:121.
  • Harachi TW, Abbott RD, Catalano RF, Haggerty KP, Flemming CB. Opening the black box: using process evaluation measures to assess implementation and theory building. Am J Comm Psych 1999;27:711.

Articles Specific to Knowledge Translation Trials

  • Oakley A, Strange V, Bonell C, Allen E, Stephenson J. Health services research: process evaluation in randomised controlled trials of complex interventions. BMJ 2006;332:413.
    Hoomans T, Severans JL. Economic evaluation of implementation strategies in health care.” Implement Sci 2014; 9:168.
  • Colquhoun HL, Lowe D, Helis E, Belanger D, Ens B, Hill S, Mayhew A, Taylor M, Grimshaw JM. Evaluation of a training program for medicines-oriented policymakers to use a database of systematic reviews. Health Res Policy Syst 2016 ;14:70.
  • Rycroft-Malone J, Seers K, Crichton N, Chandler J, Hawkes CA, Allen C, Bullock I, Strunin L. A pragmatic cluster randomized trial evaluating three implementation interventions. Implement Sci 2012; 7:80.
  • Hemming K, Girling AJ, Stick AJ, Marsh J, Lilford RJ. Sample size calculations for cluster randomised controlled trials with a fixed number of clusters. BMC Med Res Methodol 2011;11:102.
  • Hooper R, Bourke L. Cluster randomised trials with repeated cross sections: alternatives to parallel group designs. BMJ 2015; 350:h2925.
  • Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised trial: rationale, design, analysis, and reporting. BMJ 2015; 350:h391.
  • Oakley A, Strange V, Bonell C, Allen E, Stephenson J. Health services research: process evaluation in randomised controlled trials of complex interventions. BMJ 2006;332:413.
  • Hoomans T, Severans JL. Economic evaluation of implementation strategies in health care.” Implement Sci 2014; 9:168.
  • CADTH. Guidelines for the economic evaluation of health technologies: Canada. Ottawa, 2006.

This post was published by Dr. Brent Thoma on behalf of the CAEP Academic Symposium Knowledge Translation team which also included Drs. Kerstin de Wit, Janet Curran, Shawn Dowling, Eddy Lang, and Laurie Morrison.

Brent Thoma
+ Brent Thoma is a medical educator, blogging geek, and emergency physician who works at the University of Saskatchewan College of Medicine. He founded BoringEM and is a senior editor / tech support / jack-of-all trades at CanadiEM.
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  • Shawn Dowling

    This looks awesome Brent!