A pragmatic cluster randomised trial evaluating three implementation interventions
Open accessAbstract
BACKGROUND: Implementation research is concerned with bridging the gap between evidence and practice through the study of methods to promote the uptake of research into routine practice. Good quality evidence has been summarised into guideline recommendations to show that peri-operative fasting times could be considerably shorter than patients currently experience. The objective of this trial was to evaluate the effectiveness of three strategies for the implementation of recommendations about peri-operative fasting. METHODS: A pragmatic cluster randomised trial underpinned by the PARIHS framework was conducted during 2006 to 2009 with a national sample of UK hospitals using time series with mixed methods process evaluation and cost analysis. Hospitals were randomised to one of three interventions: standard dissemination (SD) of a guideline package, SD plus a web-based resource championed by an opinion leader, and SD plus plan-do-study-act (PDSA). The primary outcome was duration of fluid fast prior to induction of anaesthesia. Secondary outcomes included duration of food fast, patients' experiences, and stakeholders' experiences of implementation, including influences. ANOVA was used to test differences over time and interventions. RESULTS: Nineteen acute NHS hospitals participated. Across timepoints, 3,505 duration of fasting observations were recorded. No significant effect of the interventions was observed for either fluid or food fasting times. The effect size was 0.33 for the web-based intervention compared to SD alone for the change in fluid fasting and was 0.12 for PDSA compared to SD alone. The process evaluation showed different types of impact, including changes to practices, policies, and attitudes. A rich picture of the implementation challenges emerged, including inter-professional tensions and a lack of clarity for decision-making authority and responsibility. CONCLUSIONS: This was a large, complex study and one of the first national randomised controlled trials conducted within acute care in implementation research. The evidence base for fasting practice was accepted by those participating in this study and the messages from it simple; however, implementation and practical challenges influenced the interventions' impact. A set of conditions for implementation emerges from the findings of this study, which are presented as theoretically transferable propositions that have international relevance. TRIAL REGISTRATION: ISRCTN18046709--Peri-operative Implementation Study Evaluation (POISE).
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While the evidence was used locally, it did not impact on practice.
“While this showed the evidence was used locally, it did not impact on practice [12].”
From The role of evidence, context, and facilitation in an implementation trial: implications for the development of the PARIHS framework (2013) · cites this paper as [12]
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Fasta á undan skurðaðgerð: Leiðbeiningar til sjúklinga og lengd föstu – framskyggn könnun
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- Authors
- Rycroft-Malone, J., Seers, K., Crichton, N., Chandler, J., Hawkes, C. A., Allen, C., Bullock, I., & Strunin, L.
- Affiliations
- University of Warwick (GB)
- London South Bank University (GB)
- Cochrane (GB)
- Bangor University (GB)
- Royal College of Physicians (GB)
- Royal College of Anaesthetists (GB)
- Venue
- Implementation Science
- Published
- 2012-08-30
- Volume
- 7
- Issue
- 1
- Pages
- 80-80
- ISSN
- 1748-5908 (ISSN-L)
- PMC
- PMC3457838
- OpenAlex
- W2126260477
- Cited by
- 71
- References
- 57
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 2 · 2023: 9 · 2022: 4 · 2021: 2 · 2020: 4 · 2019: 5 · 2018: 6 · 2017: 7 · 2016: 8 · 2015: 9 · 2014: 5 · 2013: 1
- FWCI
- 8.52
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Implementation Science (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Lancaster EPrints (Lancaster University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- guideline implementation, PARIHS framework, Plan-Do-Study-Act, online intervention, opinion leaders, guideline dissemination, anesthesia, NHS hospitals, implementation barriers
- MeSH terms
- Adult, Attitude of Health Personnel, Costs and Cost Analysis, Fasting, United Kingdom, Health Plan Implementation, Humans, Inservice Training, Software Design, Time Factors, Process Assessment, Health Care, Guideline Adherence, Perioperative Care, Information Dissemination
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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