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Avoiding “a piece of paper on the wall that everyone ignores”: A qualitative study on the barriers for implementing open fracture guidelines

Lookup NU author(s): Dr Adele Pope, David Hamilton

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© 2024 The Author(s)Background: Ortho-plastic evidence-based clinical guidelines for open fractures have demonstrated to standardise care and improve outcomes for patients admitted following lower extremity trauma. Despite its benefits, very few countries have introduced such guidance. The aim of this study was to explore the attitudes, barriers and limitations to the development and implementation of guidelines for lower limb open fractures Methods: Twelve renowned orthopaedic and plastic surgeons, based in countries with no guidelines at present, underwent semi-structured interviews. A qualitative appraisal was conducted using reflexive thematic analysis methodology. Systematic coding led to the development and refinement of themes to address the research question. Results: Individualistic decision-making, reliance on multidisciplinary interpersonal relationships, and the presence of immobile determinants of open fracture care emerged as three themes that define how patients are currently managed in settings with no guidelines in place. Although guidelines can potentially improve care by presenting evidence-based recommendations, introducing audit practices, establishing pathways for multidisciplinary collaboration, and enhancing effective leadership; if barriers to the implementation are not considered, they may end up as a “piece of paper on the wall that everyone ignores” Conclusions: This study is the first to explore the challenges of introducing ortho-plastic guidelines for open extremity trauma. The themes presented describe the status quo in settings with no such protocols in place, establishing the foundation for future initiatives aiming to provide a practical strategy to aid the development and introduction of clinical guidelines for open lower limb fractures.

Publication metadata

Author(s): Berner JE, Pope A, Hamilton DW, Nanchahal J, Jain A

Publication type: Article

Publication status: Published

Journal: Injury

Year: 2024

Volume: 55

Issue: 12

Print publication date: 01/12/2024

Online publication date: 09/11/2024

Acceptance date: 07/11/2024

Date deposited: 25/11/2024

ISSN (print): 0020-1383

ISSN (electronic): 1879-0267

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.injury.2024.112018

DOI: 10.1016/j.injury.2024.112018

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