Implementation strategies in emergency management of children: A scoping review

• Published in: PloS one Vol. 16; no. 3; p. e0248826
• Main Authors: Aregbesola, Alex, Abou-Setta, Ahmed M, Okoli, George N, Jeyaraman, Maya M, Lam, Otto, Kasireddy, Viraj, Copstein, Leslie, Askin, Nicole, Sibley, Kathryn M, Klassen, Terry P
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.03.2021; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Emergency service; Hospitals; Medical protocols; Medicine and Health Sciences; Pediatric emergencies; Pediatric research; Research and Analysis Methods; Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0248826

Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children. We conducted a scoping review using Arksey and O'Malley's framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies. We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%). Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that 'dissemination' is the most common strategy used, and 'capacity building and scale-up' are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.