Background
During a public health emergency, emergency department (ED) clinicians can improve care delivery if they identify and adopt innovations that are safe and effective. However, little is known about factors that impact ED clinician decision-making around using innovations when evidence-based information is limited.
Objective
The goal of this study was to understand the processes and factors that led ED clinicians to discontinue (de-implement) using COVID-19 care innovations. Methods: This is a qualitative study using semi-structured focus groups with ED clinicians from eight hospitals across the US. Hospitals were purposively sampled and recruited to capture a diversity of perspectives based on location, facility type (academic or community hospital), rurality (urban or rural), and safety net status. Seventeen physicians, seven advanced practice providers, 18 nurses, and seven respiratory therapists participated. We utilized both inductive and deductive techniques to perform content and thematic analysis of transcripts.
Results
Clinicians shared that direct observation of patient outcomes, collaboration and discussion with ED colleagues, supply availability, and protocols from leadership contributed heavily to decisions about de-implementing innovations during the COVID-19 pandemic. Discontinuing innovations depended on the following factors: replacement (e.g., better alternate treatment options were available), seeing change from using the innovation, anticipated patient volume, the amount of new information available, and overall hospital compliance.
Conclusions
Decision-making around discontinuing innovations in ED settings during the COVID-19 pandemic was different compared to routine conditions due to the lack of information and the rapid evolution of evidence in a short period of time. The level of evidence needed to implement and de-implement the innovations was much lower. Our findings show that factors around de-implementation during a public health emergency were highly localized and treated similarly to pilot tests of new innovations. Future work is needed to create mechanisms to implement promising innovations during evolving public health emergencies and monitor their effectiveness and safety after implementation so that evidence-based decisions can be made regarding continuation of implementation or the decision to de-implement.
