TY - JOUR
T1 - Factors influencing the successful implementation of a novel digital health application to streamline multidisciplinary communication across multiple organisations for emergency care
AU - Bagot, Kathleen L.
AU - Bladin, Chris F.
AU - Vu, Michelle
AU - Bernard, Stephen
AU - Smith, Karen
AU - Hocking, Grant
AU - Coupland, Tessa
AU - Hutton, Debra
AU - Badcock, Diane
AU - Budge, Marc
AU - Nadurata, Voltaire
AU - Pearce, Wayne
AU - Hall, Howard
AU - Kelly, Ben
AU - Spencer, Angie
AU - Chapman, Pauline
AU - Oqueli, Ernesto
AU - Sahathevan, Ramesh
AU - Kraemer, Thomas
AU - Hair, Casey
AU - Dion, Stub
AU - McGuinness, Connor
AU - Cadilhac, Dominique A.
N1 - Funding Information:
The authors would like to acknowledge the members of the PROMPT (Prenotification & Real‐time cOMMunication with Pulsara Technology) Executive Committee; members of the Florey Public Health and Health Services Research team, particularly Karen Biddiscombe and Shaun Hancock; the Ambulance Victoria research and IT teams, particularly Salman Sabir, Emily Andrews and Dave McCunnie; and all of the paramedics and hospital personnel who supported the implementation of Pulsara in their team/department as part of their clinical processes and for providing feedback relevant to this research. We would also like to acknowledge the support from the US‐based Pulsara team—particularly James Woodson (CEO) and those who supported our on‐site implementations Shawn Olson, Brittany Means, Brandon Means and Brittney Nelson. Funders have had no influence in designing, conducting or presenting results. This work was supported by the Heart Foundation under Vanguard grant #101043; the Stroke Foundation under Seed grant #1724; Victorian Stroke Clinical Network; Victorian Cardiac Clinical Network; Hospital Future Fund and Boeringher Ingelheim unrestricted educational grant. Dominique A. Cadilhac is the recipient of a National Health and Medical Research Council Senior Research Fellowship (#1154273). Dion Stub is supported by a National Heart Foundation Future Leader Fellowship (#101908). Open access publishing facilitated by Monash University, as part of the Wiley ‐ Monash University agreement via the Council of Australian University Librarians. TM TM
Publisher Copyright:
© 2023 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.
PY - 2024/3
Y1 - 2024/3
N2 - Rationale: Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context. Aims: To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology. Methods: We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders). Results: Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times. Conclusion: Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.
AB - Rationale: Delivering optimal patient health care requires interdisciplinary clinician communication. A single communication tool across multiple pre-hospital and hospital settings, and between hospital departments is a novel solution to current systems. Fit-for-purpose, secure smartphone applications allow clinical information to be shared quickly between health providers. Little is known as to what underpins their successful implementation in an emergency care context. Aims: To identify (a) whether implementing a single, digital health communication application across multiple health care organisations and hospital departments is feasible; (b) the barriers and facilitators to implementation; and (c) which factors are associated with clinicians' intentions to use the technology. Methods: We used a multimethod design, evaluating the implementation of a secure, digital communication application (Pulsara™). The technology was trialled in two Australian regional hospitals and 25 Ambulance Victoria branches (AV). Post-training, clinicians involved in treating patients with suspected stroke or cardiac events were administered surveys measuring perceived organisational readiness (Organisational Readiness for Implementing Change), clinicians' intentions (Unified Theory of Acceptance and Use of Technology) and internal motivations (Self-Determination Theory) to use Pulsara™, and the perceived benefits and barriers of use. Quantitative data were descriptively summarised with multivariable associations between factors and intentions to use Pulsara™ examined with linear regression. Qualitative data responses were subjected to directed content analysis (two coders). Results: Participants were paramedics (n = 82, median 44 years) or hospital-based clinicians (n = 90, median 37 years), with organisations perceived to be similarly ready. Regression results (F(11, 136) = 21.28, p = <0.001, Adj R2 = 0.60) indicated Habit, Effort Expectancy, Perceived Organisational Readiness, Performance Expectancy and Organisation membership (AV) as predictors of intending to use Pulsara™. Themes relating to benefits (95% coder agreement) included improved communication, procedural efficiencies and faster patient care. Barriers (92% coder agreement) included network accessibility and remembering passwords. PulsaraTM was initiated 562 times. Conclusion: Implementing multiorganisational, digital health communication applications is feasible, and facilitated when organisations are change-ready for an easy-to-use, effective solution. Developing habitual use is key, supported through implementation strategies (e.g., hands-on training). Benefits should be emphasised (e.g., during education sessions), including streamlining communication and patient flow, and barriers addressed (e.g., identify champions and local technical support) at project commencement.
KW - communication barriers
KW - disruptive technology
KW - evaluation
KW - health services research
KW - implementation science
KW - patient-centred care
UR - http://www.scopus.com/inward/record.url?scp=85171468229&partnerID=8YFLogxK
U2 - 10.1111/jep.13923
DO - 10.1111/jep.13923
M3 - Article
C2 - 37721181
AN - SCOPUS:85171468229
SN - 1356-1294
VL - 30
SP - 184
EP - 198
JO - Journal of Evaluation in Clinical Practice
JF - Journal of Evaluation in Clinical Practice
IS - 2
ER -