J Pediatr Surg. 2020 Jan 30. pii: S0022-3468(20)30060-9. doi: 10.1016/j.jpedsurg.2020.01.021. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/32085916
Standardizing congenital diaphragmatic hernia care in Canada: Implementing national clinical practice guidelines.
LaRusso K1, Baird R2, Keijzer R3, Skarsgard E2, Puligandla P4.
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Abstract
PURPOSE:
We sought to identify implementation barriers and opportunities to increase utilization of the Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative’s clinical practice guideline.
METHODS:
A validated readiness assessment was sent via SurveyMonkey™ to CAPSNet site coordinators and local CDH stakeholders. The survey was open from 11/2018 to 02/2019. Data and responses were analyzed using descriptive statistics (REB 2019-4753).
RESULTS:
Eighty-six responses were received, of which 65% (n = 56/86) were fully completed. The greatest number of responses came from neonatology (n = 27), pediatric surgery (n = 25), and respiratory therapy (n = 10). Seventy-eight percent (n = 67/86) of respondents were aware of the CDH guideline, and 63% (n = 54/86) used the entire guideline, while 23% (n = 20/86) used only certain sections. Besides recommendations pertaining to fetal intervention and ECLS, interdisciplinary long-term surveillance and prenatal diagnosis were considered most difficult to implement owing to funding limitations. Most respondents (n = 49/56; 87.5%) felt they could implement >75% of the recommendations. Establishing common team goals [i.e., minimize care variations] (n = 33/58;57%), provider buy-in [commitment of all health professionals to the guideline] (n = 28/58;48%), and regular compliance assessment (n = 23/58;40%) would increase uptake.
CONCLUSION:
There is national awareness of the CDH guideline. Implementation strategies ensuring common team goals, provider buy-in, and regular compliance assessment should increase guideline uptake/utilization. Consolidating funding for interdisciplinary long-term surveillance and prenatal diagnosis is necessary for any site-specific implementation strategy.
LEVEL OF EVIDENCE:
Level 4 qualitative, survey.
Copyright © 2020 Elsevier Inc. All rights reserved.
KEYWORDS:
Clinical practice guidelines; Congenital diaphragmatic hernia; Implementation barriersPMID: 32085916 DOI: 10.1016/j.jpedsurg.2020.01.021
