Table 1 Specification of Implementation Strategies (Site- and Study-Provided)
Care pathway “bundle” strategies (up to sites to offer) | Centralized study-offered implementation support (offered to all sites) | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Deliver structured educational program | Clinician pre-commitment | Point-of-care nudge | Facilitate Medication Access | Rapid follow-up | Needs assessment and pathway tailoring | Prepare structured educational program | Coaching for CQI champion | Build a coalition to support implementation | External peer support | Data audit | Provide technical assistance with FAQ and EHR components | |
Primary Actor(s) | Clinical champions; Study staff | Clinical champions | Clinical champions; Site IT staff | Clinical champions | Clinical champions | Study staff | Study staff | Study staff | Study staff | Study staff; Clinical champions | Study staff, MEDIC staff | Study staff; Clinical champion |
Action(s) | Organize an educational session with clinicians and deliver the educational content prepared by the study team | Design & offer opportunity for clinicians at site to pre-commit to using low-risk PE discharge pathway | Establish point-of-care nudge to help providers identify low-risk PE patients (e.g., EHR-integrated interruptive alert or checklist) | Establish a pathway for providing rapid and reliable access to anticoagulant medications upon ED discharge | Establish a pathway for rapid follow-up with an outpatient clinician shortly after ED discharge | Assess site needs & determinants; help sites tailor the low-risk PE pathway to site needs & capabilities | Prepare educational materials that address knowledge gaps, provide baseline data, inform about site-specific barriers, and detail the workflow package components | Offer phone-based, individualized coaching to site clinical champions to address barriers to care bundle adoption | Engage site champions & stakeholders to identify internal stakeholders to join a working group coalition that will lead the low-risk PE discharge intervention at each site | Offer opportunities for implementing sites to reflect on the implementation effort, share lessons learned, & support learning external to their individual site | Monitor & disseminate data on use of low-risk PE discharge pathway | Provide clinical champions with access to FAQ documents and EHR tools for point-of-care nudge implementation |
Targets of the action | Frontline ED clinicians | Frontline ED clinicians | Frontline ED clinicians | Frontline ED clinician | Frontline ED clinician | Clinical champions | Frontline ED clinicians | Clinical champions | Clinical champions | Clinical champions & stakeholders | Clinical champions & stakeholders | Clinical champion |
Temporality | Offered at least once during implementation phase (typically last month) | Following educational session | System set up during implementation phase; messages delivered at time of clinical encounter | Occurs upon decision to discharge from ED but prior to patient leaving the ED | Occurs upon decision to discharge from ED but prior to patient leaving the ED | Pre-implementation phase | Offered at least once during implementation phase (typically last month) | Implementation phase | Throughout implementation phase | Throughout the six-month implementation period | Post implementation phase | Throughout the six-month implementation phase |
Dose | One session | Once following each educational offering | Once per low-risk PE clinical encounter | Once per low-risk PE clinical encounter | Once per low-risk PE clinical encounter | Once | Once prior to site roll-out; upon request (up to two more times) during post-implementation | Every two weeks during implementation phase; monthly for the first six months of the post-implementation phase, quarterly thereafter | Every two weeks during implementation phase; monthly for the first six months of the post-implementation phase, quarterly thereafter | At least once during the implementation phase; every three months post-implementation phase | Monthly for the first six months of the post-implementation phase, quarterly thereafter | Anytime during the implementation phase |
Implementation outcome(s) affected | Acceptability, adoption, implementation fidelity, reach, maintenance | Adoption, implementation fidelity | Reach, adoption, implementation fidelity, maintenance | Adoption, implementation fidelity, maintenance | Adoption, implementation fidelity, maintenance | Feasibility, appropriateness, adoption, implementation fidelity, maintenance | Acceptability, adoption, implementation fidelity, reach, maintenance | Adoption, implementation fidelity, maintenance | Adoption, implementation fidelity, maintenance | Adoption, implementation fidelity, maintenance | Adoption, maintenance | Adoption, implementation fidelity, maintenance |
Justification | Clinician training builds knowledge & capability among ED clinicians to ensure know how & when to discharge low-risk PE patients | Commitment mechanisms help clinicians adopt new practices by encouraging them to commit prior to a time-sensitive clinical encounter when heuristics may prevail | Reminders help clinicians adopt new practices reminding them about available pathways & commitments to use them | Addresses an important barrier identified by ED clinicians | Addresses an important barrier identified by ED clinicians | Helps the study team understand barriers to be addressed by implementation efforts & tailors care pathway components to what is feasible for site | Clinician training builds knowledge & capability among ED clinicians to ensure know how & when to discharge low-risk PE patients | Provides hands-on, tailored support to address barriers & help further tailor effort | Ensures that clinical champions feel empowered to support effort & minimizes turnover &/or replacement time | Peer learning & collaboration improves implementation by allowing sites to learn from one another | Sharing data helps sites see how/whether they are improving & how their rates of utilization compare to other sites | Provide sits with technical resources so that they do not need to re-create EHR tools or resources for rapid follow up clinicians |