• Perioperative Glucose Management in Orthopedic Surgery

      Madden, Ann Rose; Amos, Veronica Y. (2019-05)
      Background: There is a definitive correlation between perioperative hyperglycemia and negative outcomes in orthopedic surgeries. Vigilant treatment of hyperglycemia (>180 mg/dL) will prevent negative outcomes such as joint failure, infection and pseudarthrosis. Local Problem: A Clinical Practice Guideline (CPG) focusing on the management of perioperative hyperglycemia for patients undergoing orthopedic surgery was created for a community hospital in Southern Maryland. Interventions: Data was collected using the following instruments: Practitioner Feedback Questionnaire (PFQ) and the Appraisal of Guidelines Research and Evaluation II Tool (AGREE II). The acceptance and usability of the clinical practice guideline (CPG) was evaluated through these instruments. Results: The dissemination and collection of the practitioner feedback survey resulted in a 100% response (N=16). The literature search was complete and relevant and the recommendations of the CPG were clear and suitable for the intended patient population. 90% of the clinician’s scores suggested they would feel comfortable utilizing the care model suggested in the CPG. Clinical expertise and demographic variables influenced the responses in the PFQ and Agree II tool. Conclusions: Overall the data collected demonstrated widespread acceptance and approval of this clinical practice guideline.
    • A qualitative analysis of the implementation of a complex intervention: evaluating implementation of the Trauma Survivors Network

      Frey, Katherine Parris; Lipscomb, Jane (2017)
      Background: Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically. Purpose: The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified. Methods: In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level. Results: The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.