Abstract：
OBJECTIVE: Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies.
METHODS: A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
RESULTS: Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
CONCLUSIONS: Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
BACKGROUND: Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
METHODS: A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes.
RESULTS: Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning.
CONCLUSIONS: Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability.
BACKGROUND: Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
摘要：
目的：小儿烧伤是一个全球性的临床问题，发病率很高。早期辅助负压伤口治疗可提高烧伤患儿的再上皮形成率，然而，在急性烧伤护理中的采用是不一致的。这项调查旨在确定在小儿烧伤的急性管理中实施辅助负压伤口治疗的障碍，并共同设计有针对性的实施策略。
方法：采用序贯混合方法设计，探讨在急性小儿烧伤护理中实施辅助负压伤口治疗的障碍。向澳大利亚四家主要儿科医院的医疗保健专业人员分发了一份在线问卷，每个都有专门的烧伤服务。根据实施研究综合框架(CFIR)对障碍进行编码。与高级临床医生的半结构化访谈针对当地情况量身定制了实施策略。利益相关者共识会议合并了实施策略和本地流程。
结果：63名医疗保健专业人员参加了问卷调查，半结构化访谈涉及9名资深烧伤临床医生。我们在所有五个CFIR领域中确定了八个实施障碍，然后共同设计了针对性策略来解决已确定的障碍。障碍包括缺乏可用资源，获得知识和信息的机会有限，个别阶段的变化，患者的需求和资源，关于干预的知识和信念有限，缺乏外部政策，干预复杂性，执行规划差。
结论：多种背景因素影响急性小儿烧伤患者负压伤口治疗的摄取。结果将为多状态阶梯式楔形集群随机对照试验提供信息。额外资源,教育,培训,更新的策略，和指导方针是成功实施的必要条件。预计辅助负压伤口治疗，结合量身定制的实施策略，将提高采用率和可持续性。
背景：澳大利亚和新西兰临床试验注册：ACTRN12622000166774。2022年2月1日注册。
方法：采用序贯混合方法设计，探讨在急性小儿烧伤护理中实施辅助负压伤口治疗的障碍。向澳大利亚四家主要儿科医院的医疗保健专业人员分发了一份在线问卷，每个都有专门的烧伤服务。根据实施研究综合框架(CFIR)对障碍进行编码。与高级临床医生的半结构化访谈针对当地情况量身定制了实施策略。利益相关者共识会议合并了实施策略和本地流程。
结果：63名医疗保健专业人员参加了问卷调查，半结构化访谈涉及9名资深烧伤临床医生。我们在所有五个CFIR领域中确定了八个实施障碍，然后共同设计了针对性策略来解决已确定的障碍。障碍包括缺乏可用资源，获得知识和信息的机会有限，个别阶段的变化，患者的需求和资源，关于干预的知识和信念有限，缺乏外部政策，干预复杂性，执行规划差。
结论：多种背景因素影响急性小儿烧伤患者负压伤口治疗的摄取。结果将为多状态阶梯式楔形集群随机对照试验提供信息。额外资源,教育,培训,更新的策略，和指导方针是成功实施的必要条件。预计辅助负压伤口治疗，结合量身定制的实施策略，将提高采用率和可持续性。
背景：澳大利亚和新西兰临床试验注册：ACTRN12622000166774。2022年2月1日注册。
