Background
Conceptual framework
Methods
Study design and sample selection
Survey development
Definition of main outcome
Creation of covariate composite scores
Analysis
Results
Facility and respondent characteristics
All respondents | Less successful implementation | More successful implementation | |||||
---|---|---|---|---|---|---|---|
N = 368 | N = 127 (34.5%) | N = 241 (65.5%) | |||||
Variables |
n
| % |
n
| % |
n
| % | p value |
Facility characteristics | |||||||
Number of ORs | 0.0014*‡ | ||||||
0–4 | 90 | 24.5 | 17 | 13.4 | 73 | 30.3 | |
5–15 | 119 | 32.3 | 43 | 33.9 | 76 | 31.5 | |
16–30 | 83 | 22.6 | 37 | 29.1 | 46 | 19.1 | |
≥ 30 | 74 | 20.1 | 30 | 23.6 | 44 | 18.3 | |
Missing | 2 | 0.5 | 0 | 0.0 | 2 | 0.8 | |
Anesthesiology or surgical residents | 175 | 47.6 | 66 | 52.0 | 109 | 45.2 | 0.2184 |
Respondent characteristics | |||||||
Primary professional role | 0.179 | ||||||
Anesthesiology | 311 | 84.5 | 114 | 89.8 | 197 | 81.7 | |
Surgery | 13 | 3.5 | 2 | 1.6 | 11 | 4.6 | |
OR staff | 24 | 6.5 | 7 | 5.5 | 17 | 7.1 | |
Other | 20 | 0.1 | 4 | 0.0 | 16 | 0.1 | |
Employer† | 0.9687 | ||||||
Facility or university | 118 | 32.1 | 44 | 34.7 | 74 | 30.7 | |
Physician owned practice | 93 | 25.3 | 34 | 26.8 | 59 | 24.5 | |
Corporate practice | 51 | 13.9 | 20 | 15.8 | 31 | 12.9 | |
Independent solo practice | 27 | 7.3 | 9 | 7.1 | 18 | 7.5 | |
Missing | 79 | 21.5 | 20 | 15.8 | 59 | 24.5 | |
Years since professional training | 0.4534‡ | ||||||
Less than 5 years | 31 | 8.4 | 12 | 9.5 | 19 | 7.9 | |
5–10 years | 40 | 10.9 | 15 | 11.8 | 25 | 10.4 | |
11–20 years | 80 | 21.7 | 29 | 22.8 | 51 | 21.2 | |
≥ 20 years | 198 | 53.8 | 66 | 52.0 | 132 | 54.8 | |
Missing | 19 | 5.2 | 5 | 3.9 | 14 | 5.8 |
Organizational context
Structural characteristics
Quality improvement initiatives
Barriers and facilitators
Implementation process
Covariate composite scores
More successful implementation | ||||
---|---|---|---|---|
Variable | Total N |
N
| % | MH p value |
Number of patient safety/quality improvement initiatives† | 0.0049* | |||
1 | 53 | 29 | 54.7 | |
2 | 59 | 32 | 54.2 | |
3 | 89 | 59 | 66.3 | |
4 | 79 | 60 | 76.0 | |
5 | 78 | 55 | 70.5 | |
Missing | 10 | 6 | 60.0 | |
Number of cognitive aid implementation steps completed‡ | < 0.0001* | |||
0 | 39 | 10 | 25.6 | |
1 | 52 | 19 | 36.5 | |
2 | 67 | 41 | 61.2 | |
3 | 60 | 42 | 70.0 | |
4 | 45 | 38 | 84.4 | |
5 | 35 | 27 | 77.1 | |
6 | 42 | 39 | 92.9 | |
7 | 15 | 13 | 86.7 | |
8 | 13 | 12 | 92.3 | |
Missing | 0 | 0 | 0.0 | |
Number of other ways in which tool is used§ | < 0.0001* | |||
0 | 73 | 39 | 53.4 | |
1 | 146 | 87 | 59.6 | |
2 | 91 | 68 | 74.7 | |
3 | 42 | 36 | 85.7 | |
4 | 12 | 11 | 91.7 | |
Missing | 4 | 0 | 0.0 |
Predictors of regular OR cognitive aid use
Predictor | Odds ratio | 95% confidence interval | p value |
---|---|---|---|
Number of implementation steps (out of 8)† | 1.57 | 1.31–1.87 | < 0.0001* |
Number of operating rooms | 0.0203* | ||
0–4 | 4.11 | 1.66–10.18 | 0.0092* |
5–15 | 2.20 | 1.01–4.80 | 0.6446 |
16–30 | 1.69 | 0.73–3.91 | 0.5367 |
≥ 30 | Reference group | n/a | n/a |
Number of other ways in which tool was used (out of 4)‡ | 1.41 | 1.03–1.92 | 0.0328* |
Enabled tool implementation—support of my department or institution leadership | 3.26 | 1.80–5.91 | < 0.0001* |
Enabled tool implementation—time to train staff | 3.75 | 1.24–11.28 | 0.0189* |
Challenge to implement—clinical providers resisted using tool | 0.18 | 0.08–0.38 | < 0.0001* |
Challenge to implement—absence of committed implementation champion | 0.44 | 0.23–0.84 | 0.0126* |
Challenge to implement—found content or design of tool unsatisfactory | 0.11 | 0.02–0.61 | 0.0112* |