Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

TY - JOUR

T1 - Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

AU - Bosch, Marije Caroline

AU - McKenzie, Joanne Ellen

AU - Mortimer, Duncan Stuart

AU - Tavender, Emma Jane

AU - Francis, Jill J

AU - Brennan, Sue Ellen

AU - Knott, Jonathan C

AU - Ponsford, Jennie Louise

AU - Pearce, Andrew C

AU - O'Connor, Denise Ann

AU - Grimshaw, Jeremy M

AU - Rosenfeld, Jeffrey Victor

AU - Gruen, Russell Lindsay

AU - Green, Sally Elizabeth

AU - Bayley, Mark Theodore

AU - Buchan, Heather A

AU - Cameron, Peter

AU - Cooper, David James

AU - Ellis, Niki

AU - Fitzgerald, Mark

AU - Huckson, Sue D

AU - Joseph, Anthony

AU - Morley, Peter

AU - Khan, Farees

AU - Lavis, John N

AU - Marshall, Shawn C

AU - Michie, Susan

AU - Rushworth, Nick

AU - Sherry, Lisa

AU - Clavisi, Ornella Maria

AU - Cooksley, David G

AU - Harris, Claire

AU - Kaye, Andrew H

AU - McDonald, Steven

AU - Morokoff, Andrew

AU - Zobel, Justin

AU - Goergen, Stacy Kellan

AU - Meares, Susanne

AU - Smyth, Tracy

AU - Chau, Marisa

AU - Varanelli, Laura

PY - 2014

Y1 - 2014

N2 - Background: Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed.Methods/design: The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervent

AB - Background: Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed.Methods/design: The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervent

U2 - 10.1186/1745-6215-15-281

DO - 10.1186/1745-6215-15-281

M3 - Article

VL - 15

SP - 1

EP - 20

JO - Trials

JF - Trials

SN - 1745-6215

IS - 281

ER -