A systematic approach to identifying and developing implementation strategies to support the uptake of a risk tool to aid in clinical management of patients with syncope: A qualitative study (Preprint)

BACKGROUND The Canadian Syncope Risk Score (CSRS) was developed to improve syncope management in emergency department (ED) settings. Evidence-based tools often fail to have the intended impact due to suboptimal uptake or poor implementation. OBJECTIVE This paper describes the process of developing evidence-based implementation strategies to support the deployment and use of the CSRS in real-world ED settings to improve syncope management among physicians. METHODS We followed French et al.’s approach for intervention development, including: (1) Identifying who needs to do what differently; (2) Identifying the barriers and enablers to be addressed; (3) Identifying the intervention components and modes of delivery to overcome the identified barriers. We used the behaviour change wheel to guide the selection of implementation strategies. We engaged CSRS end-users (i.e emergency medicine physicians) in a user-centered design approach to generate and refine strategies. This was achieved over a series of three qualitative user-centered design workshops lasting 90-minutes each with three groups of emergency medicine physicians. RESULTS Fourteen physicians participated across the workshops. The themes are organized according to French et al. intervention development steps: Theme 1 - Identifying and refining barriers; Theme 2 - Identifying the intervention components and modes of delivery. The theme 2 is sub-divided in two sub-themes: 2.1. Generating high-level strategies and developing strategies prototypes, 2.2. Refining and testing strategies. The main strategies identified to overcome barriers included education in the format of meetings, videos, journal clubs, and posters (to address uncertainty around when and how to apply the CSRS); development of an online calculator and integration into the electronic medical record (to address uncertainty in how to apply the CSRS); a local champion (to address lack of team buy-in); and dissemination of evidence summaries and feedback through email communications (to address a lack of evidence about impact). CONCLUSIONS The ability of the CSRS to effectively improve patient safety and syncope management relies on broad buy-in and uptake across physicians. To ensure the CSRS is well-positioned for impact, a comprehensive suite of strategies was identified to address known barriers. CLINICALTRIAL