Table 2 Key findings and implementation strategies deployed to address them using Iterative RE-AIM
Key findings | Quantitative data | Qualitative data | Implementation strategies deployed that addressed key finding ERIC [23] Strategy type |
|---|---|---|---|
There are specific COVID-19 barriers to implementation that impact Reach | Thirty-seven percent of patients who received LUS during the data collection period were patients without COVID-19, despite implementation strategies being focused on use in patients with COVID-19 | Perceived increased time in the patient’s room, extra time required to disinfect equipment, and perceived lack of evidence of patient benefit were all unique barriers to LUS use in patients with COVID-19 | Distribute educational materials - Circulate academic studies demonstrating benefits of use of LUS for patients with COVID-19. Revise professional roles - Ensure there is someone who can obtain LUS images for clinicians directly caring for patients to overcome COVID-19-specific barriers of perceived increased risk of infection, transition, and time spent |
Clinicians are more willing to order and make clinical decisions using LUS images than acquire images themselves | Forty-three hospitalist faculty ordered LUS for their patients during the data collection period, but only 8 hospitalist individuals performed or supervised the acquisition of these LUS exams | Lack of time to train and perform LUS were important general barriers to full adoption [25] | Train the trainer Subgroup of hospitalists (procedure attendings) made responsible for acquiring LUSs for other hospitalists |
Changing the practice context by mandating credentialing and use among a strategically selected group may increase the likelihood of adoption and implementation. | Of the 4 faculty who completed training during the study period only 1 was not a procedure attending (75% adoption among eligible procedure service attendings vs. 1.2% adoption among non-procedure service attendings) | Lack of time to train and perform LUS were the important general barriers to full adoption and implementation [25] | Mandate change - Require credentialing and use of LUS by a strategically selected subgroup of clinicians (i.e., procedure service faculty) |