Grant: Project Grant

Frequent failure to implement best evidence into patient care practices is arguably the largest deficiency in modern healthcare, resulting in suboptimal patient care, preventable medical errors, and increased morbidity and mortality. There is a growing body of literature which suggests that the removal of ineffective (i.e. low-value) or harmful clinical practices (i.e. de-adoption) is integral to both the delivery of high quality care and the sustainability of our healthcare system. To improve our understanding of the process of de-adoption, members of our team have reviewed the literature, resulting in a conceptual framework for de-adoption. Results from this background work revealed that few studies have actually examined how to successfully de-adopt an intervention that is already integrated into clinical practice. The objective of this study is to determine top barriers and facilitators to de-adoption and associated KT interventions proven to be effective as a fundamental step in the development of an applied framework to guide the de-adoption process. To achieve our objective, we propose to use Canadian general system intensive care units (ICU) as our laboratory of investigation and employ a three phased mixed-methods approach: 1) a systematic review to identify published barriers and facilitators to de-adoption in healthcare (Phase I); 2) surveys with critical care stakeholders to identify important barriers and facilitators not published in the literature (Phase II); 3) individual follow up interviews with critical care stakeholders to further understand the structure and process of de-adoption (Phase III). Results from all three phases of work will be synthesized to develop an evidence-informed framework of barriers and facilitators that is integrated with targeted KT interventions to initiate, execute and sustain de-adoption initiatives in Canadian ICUs. Future studies will evaluate and adapt the framework to other clinical settings.