Cited by 37Health Sciences Research and EducationHealth Policy Implementation ScienceClinical practice guidelines implementation

Why do we fail to deliver evidence-based practice in critical care medicine?

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Weiss, Curtis H.·2017·Current Opinion in Critical Care

Abstract

Purpose of review: The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine. Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices. Recent findings: The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR). Barriers to the management of patients with acute respiratory distress syndrome (ARDS) include ARDS under-recognition. Barriers to the use of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle for mechanically ventilated patients and the sepsis bundle include patient-related, clinician-related, protocol-related, contextual-related, and intervention-related factors. Although these many barriers can be classified into all five CFIR domains (intervention, outer setting, inner setting, individuals, and process), most barriers fall within the individuals and inner setting domains. Summary: There are many barriers to the implementation of evidence-based practice in critical care medicine. Systematically classifying these barriers allows implementation researchers and clinicians to design targeted implementation strategies, giving them the greatest chance of success in improving the use of evidence-based practice.

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  • There is still a gap in the implementation of highly effective strategies in controlled studies, which fail to demonstrate such effectiveness after their implementation.

    “It is evident that there is still a gap in the implementation of highly effective strategies in controlled studies, which fail to demonstrate such effectiveness after their implementation [15–17]”

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Authors
Weiss, C. H.
Affiliations
Northwestern University (US)
Corresponding author
Weiss, Curtis H.
Venue
Current Opinion in Critical Care
Published
2017-10
Volume
23
Issue
5
Pages
400-405
ISSN
  • 1070-5295 (ISSN-L)
  • 1531-7072
OpenAlex
W2741538110
Cited by
37
References
56
Citations by year
2026: 2 · 2025: 2 · 2024: 8 · 2023: 7 · 2022: 8 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 1
FWCI
0.24
Type
journal article
Language
en
Open access
Locations
  • Current Opinion in Critical Care (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (K23HL118139)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
evidence-based practice, implementation barriers, intensive care, Consolidated Framework for Implementation Research, acute respiratory distress syndrome, delirium management, early mobilization, sepsis bundle, mechanical ventilation, implementation strategies
MeSH terms
Critical Care, Respiration, Respiration, Artificial, Respiratory Distress Syndrome, Evidence-Based Medicine, Evidence-Based Practice

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