Emergency Medical Services Leadership Perspectives on Implementation of Evidence-Based Guidelines: A Qualitative Study

Abstract

Introduction: Prehospital evidence-based guidelines (EBGs) are developed to optimize clinical outcomes for emergency medical services (EMS) patients. However, widespread implementation of EBGs is often inconsistent. Therefore, this study aimed to assess the baseline knowledge and practices of EMS leaders related to EBG implementation.

Methods: This was a qualitative study using focus groups to assess prehospital implementation awareness and knowledge. Participants were EMS EBG authors, EMS medical directors, and EMS professional organization leaders. Focus groups were held via video conference, audio recorded, and transcribed. Thematic coding used domains and constructs of the Consolidated Framework for Implementation Research (CFIR).

Results: Six focus groups were conducted with a total of 18 participants. A total of 1,044 codes were analyzed. “Process” was the CFIR domain with the most codes (n = 350, 33.5%), followed by the “inner setting” (the EMS agency; n = 250, 23.9%), “characteristics of the intervention” (n = 203, 19.4%), “outer setting” (the health care system and community the EMS agency serves, and the broader national EMS professional context; n = 141, 13.5%), and “characteristics of individuals” (n = 100, 9.6%). The ten most frequent constructs across all domains were: reflecting and evaluating, executing, cosmopolitanism, planning, external policy and incentives, design quality and packaging, learning climate, culture, complexity, and other personal attributes.

Conclusion: EMS leadership and stakeholder views on EBG implementation identified dominant themes related to the process of implementation and the culture and learning/implementation climate of EMS agencies. Opinions were mixed on the utility of the CFIR as a potential guide for EMS implementation. Further work is required to gain the frontline EMS clinician perspective on implementation and tie key themes to quantitative prehospital implementation outcomes.

Authors’ Contributions

CG: study design and conceptualization, data collection, data analysis and interpretation, manuscript editing; JB, SB: data collection, manuscript editing; SP: data collection, data interpretation, manuscript editing; RGS, CMG, CTR, ARP: study design and conceptualization, data interpretation, manuscript editing; JNF: study design and conceptualization, acquisition of funding, data collection, data analysis and interpretation, primary drafting of manuscript and revisions.

Disclosure Statement

The authors (CG, JB, SP, SB, RGS, CMG, CTR, ARP, JNF) report no potential conflicts of interest. The authors alone are responsible for the content and writing of this manuscript.

Additional information

Funding

Research reported in this publication was supported by the University of Florida Clinical and Translational Sciences Institute, which is supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. Dr. Fishe’s activity on this study was supported in part by a career development award from NIH/NHLBI (K23HL149991). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.