Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)

Craig, Louise E.; McInnes, Elizabeth; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A.; Considine, Julie; Middleton, Sandy

doi:10.1186/s13012-016-0524-1

Cited by 87Health Policy Implementation ScienceAcute Ischemic Stroke ManagementClinical practice guidelines implementation

Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)

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Craig, Louise E., McInnes, Elizabeth, Taylor, Natalie, Grimley, Rohan, Cadilhac, Dominique A., Considine, Julie, Middleton, Sandy·2016·Implementation Science

DOI 10.1186/s13012-016-0524-1PMC PMC5126852

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Abstract

BACKGROUND: Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED. METHODS: Studies of any design, conducted in ED, where barriers or enablers based on primary data were identified for one or more of these six clinical behaviours. Major biomedical databases (CINAHL, OVID SP EMBASE, OVID SP MEDLINE) were searched using comprehensive search strategies. The barriers and enablers were categorised using the theoretical domains framework (TDF). The behaviour change technique (BCT) that best aligned to the strategy each enabler represented was selected for each of the reported enablers using a standard taxonomy. RESULTS: Five qualitative studies and four surveys out of the 44 studies identified met the selection criteria. The majority of barriers reported corresponded with the TDF domains of "environmental, context and resources" (such as stressful working conditions or lack of resources) and "knowledge" (such as lack of guideline awareness or familiarity). The majority of enablers corresponded with the domains of "knowledge" (such as education for physicians on the calculated risk of haemorrhage following intravenous thrombolysis [tPA]) and "skills" (such as providing opportunity to treat stroke cases of varying complexity). The total number of BCTs assigned was 18. The BCTs most frequently assigned to the reported enablers were "focus on past success" and "information about health consequences." CONCLUSIONS: Barriers and enablers for the delivery of key evidence-based protocols in an emergency setting have been identified and interpreted within a relevant theoretical framework. This new knowledge has since been used to select specific BCTs to implement evidence-based care in an ED setting. It is recommended that findings from similar future reviews adopt a similar theoretical approach. In particular, the use of existing matrices to assist the selection of relevant BCTs.

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The TDF has previously been successfully applied for systematic reviews in other contexts.
“The theoretical domains framework (TDF) [24] has previously been successfully applied for systematic reviews in other contexts [25,26].”
From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [25]

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Additional file 1 of Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview
Correa, V. C., Agudelo, L. H. L., Aguirre-Acevedo, D. C., Contreras, J. A. P., Borrero, A. M. P., Patiño-Lugo, D. F., & Valencia, D. A. C. (2020) · Figshare · doi:10.6084/m9.figshare.12585929
Additional file 2 of Individual, health system, and contextual barriers and facilitators for the implementation of clinical practice guidelines: a systematic metareview
Correa, V. C., Agudelo, L. H. L., Aguirre-Acevedo, D. C., Contreras, J. A. P., Borrero, A. M. P., Patiño-Lugo, D. F., & Valencia, D. A. C. (2020) · Figshare · doi:10.6084/m9.figshare.12585932
Additional file 2 of Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome
Dmitriew, C., & Ohle, R. (2021) · Figshare · doi:10.6084/m9.figshare.14737160
Additional file 1 of Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome
Dmitriew, C., & Ohle, R. (2021) · Figshare · doi:10.6084/m9.figshare.14737157
Additional file 1 of Identifying barriers and facilitators to primary care practitioners implementing health assessments for people with intellectual disability: a Theoretical Domains Framework-informed scoping review
Caltabiano, P., Bailie, J., Laycock, A. F., Shea, B., Dykgraaf, S. H., Lennox, N. G., Ekanayake, K., & Bailie, R. (2024) · Figshare · doi:10.6084/m9.figshare.26707667
Additional file 2 of Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers’ perspective
Hwong, W. Y., Ng, S. W., Tong, S. F., Ab Rahman, N., Law, W. C., Wong, S. K., Puvanarajah, S. D., Mohd Norzi, A., Lian, F. S., & Sivasampu, S. (2024) · Figshare · doi:10.6084/m9.figshare.24953230
Additional file 1 of Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers’ perspective
Hwong, W. Y., Ng, S. W., Tong, S. F., Ab Rahman, N., Law, W. C., Wong, S. K., Puvanarajah, S. D., Mohd Norzi, A., Lian, F. S., & Sivasampu, S. (2024) · Figshare · doi:10.6084/m9.figshare.24953210
Additional file 1 of Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE)
Martinez, R. G., Weiner, B. J., Meza, R. D., Dorsey, S., Palazzo, L. G., Matson, A., Bain, C. E., Mettert, K. D., Pullmann, M. D., & Lewis, C. C. (2023) · Figshare · doi:10.6084/m9.figshare.24655904
Additional file 3 of Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome
Dmitriew, C., & Ohle, R. (2021) · Figshare · doi:10.6084/m9.figshare.14737163
Additional file 4 of Barriers and facilitators affecting implementation of the Canadian clinical practice guidelines for the diagnosis of acute aortic syndrome
Dmitriew, C., & Ohle, R. (2021) · Figshare · doi:10.6084/m9.figshare.14737166
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Additional file 4: of Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T3 Trial
Craig, L., Taylor, N., Grimley, R., Cadilhac, D., McInnes, E., Phillips, R., Dale, S., O’Connor, D., Levi, C., Fitzgerald, M., et al. (2017) · Figshare · doi:10.6084/m9.figshare.5216635
Self-citation
Additional file 1: of Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T3 Trial
Craig, L., Taylor, N., Grimley, R., Cadilhac, D. A.-M., McInnes, E., Phillips, R., Dale, S., O’Connor, D., Levi, C., Fitzgerald, M., et al. (2017) · Figshare · doi:10.6084/m9.figshare.5216587
Self-citation
Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T3 Trial
Craig, L., Taylor, N. J., Grimley, R., Cadilhac, D. A.-M., McInnes, E., Phillips, R., Dale, S., O’Connor, D. A., Levi, C. R., Fitzgerald, M., et al. (2017) · Implementation Science · doi:10.1186/s13012-017-0616-6 · Cited by 60 · see citing works
Self-citation
Additional file 2: of Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): the T3 Trial
Craig, L., Taylor, N., Grimley, R., Cadilhac, D., McInnes, E., Phillips, R., Dale, S., O’Connor, D., Levi, C., Fitzgerald, M., et al. (2017) · Figshare · doi:10.6084/m9.figshare.c.3828991_d2
Self-citation
Health professionals' views on the barriers and enablers to evidence-based practice for acute stroke care: a systematic review
Baatiema, L., Otim, M., Mnatzaganian, G., Aikins, A. D., Coombes, J. S., & Somerset, S. M. (2017) · Greater South Information System · doi:10.60692/3s072-2db76

Authors: Craig, L. E., McInnes, E., Taylor, N., Grimley, R., Cadilhac, D. A., Considine, J., & Middleton, S.
Affiliations: Nursing Research Institute (AU)
Macquarie University (AU)
The University of Queensland (AU)
The University of Melbourne (AU)
Deakin University (AU)
Corresponding author: Craig, Louise E.
ORCID: Craig, Louise E.
McInnes, Elizabeth
Taylor, Natalie
Grimley, Rohan
Cadilhac, Dominique A.
Considine, Julie
Middleton, Sandy
Venue: Implementation Science
Publisher: Springer Science and Business Media LLC
Published: 2016-11-28
Volume: 11
Issue: 1
Pages: 157-157
ISSN: 1748-5908 (ISSN-L)
DOI: 10.1186/s13012-016-0524-1
PMC: PMC5126852
OpenAlex: W2558253728
Cited by: 87
References: 40
Citations by year: 2026: 9 · 2025: 6 · 2024: 16 · 2023: 10 · 2022: 6 · 2021: 15 · 2020: 13 · 2019: 3 · 2018: 8 · 2017: 1
FWCI: 0.76
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: Implementation Science (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Monash University Research Portal (Monash University) (submittedVersion, other-oa)
Minerva Access (University of Melbourne) (submittedVersion, cc-by)
Research Bank (Australian Catholic University) (submittedVersion, cc-by)
Figshare (submittedVersion, cc-by)
Griffith Research Online (submittedVersion, cc-by)
Funders: Australian Catholic University (1063761)
Medical Research Council
National Health and Medical Research Council (1024812, 1063761)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: acute stroke, emergency department, stroke triage, intravenous thrombolysis, tissue plasminogen activator, patient transfer, temperature control, glycemic control, dysphagia, barriers and facilitators, Theoretical Domains Framework, behaviour change techniques, guideline implementation, clinician knowledge and skills
MeSH terms: Adult, Clinical Competence, Deglutition Disorders, Emergency Service, Hospital, Emotions, Female, Humans, Male, Medical Staff, Hospital, Patient Transfer, Tissue Plasminogen Activator, Quality Assurance, Health Care, Self Concept, Triage, Stroke, Professional Role, Intention

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Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF)

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