336 Exploring the barriers and facilitators to screening in Emergency Departments (ED): a qualitative evidence synthesis using the theoretical domains framework

Abstract Background Validated screening tools, such as the Identification of Seniors At-Risk tool, can be utilised to detect early disease processes, risk factors and the risk of adverse outcomes. Identifying individuals in need of early intervention and targeted assessment can be achieved by implementing screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review identified barriers and facilitators to screening in the ED to underpin implementation processes. Furthermore, this review focused on synthesising the experience of healthcare workers who are routinely involved in this process. Methods A rigorous search strategy was employed and reported using PRISMA. Subsequently, an a-priori framework of themes was formulated to facilitate the interpretation of search results. A conceptual model was then formed using ‘Best fit’ framework synthesis, this assisted in the organisation of data from relevant studies during data extraction. Dual blind screening of results was undertaken using RAYYAN as a platform. Thirty studies met the inclusion criteria. Dual appraisal of full text articles was completed using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively. Results This is the first known synthesis of qualitative research, focused on screening in the ED. Predominantly, the findings illustrate that screening in the ED is perceived as a complex and challenging process. The barriers and facilitators identified can be broadly categorised as identifying preconditions to screen, recognising motivations to screen and acknowledging the required knowledge and skills to screen. Conclusion Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were facilitators.