Barriers and Facilitators to the Implementation of 20 Minutes of Cool Running Water into Emergency Clinical Practice as a First Aid Treatment for Burn Injuries: A Mixed Methods Investigation

Fiona Wood, Maleea D. Holbert, Yvonne Singer, Tina Palmieri, John Rose, Kevin Mackey, Sonia Singh, Nathan Kuppermann, Victor Joe, Tanesha A. Dimanopoulos, Cody C. Frear, Steven M. McPhail, Roy M. Kimble, Leila Cuttle, Robert Katzer, Bronwyn Griffin

Research output: Working paperPreprint

Abstract

Background: Application of 20 minutes of cool running water (20CRW) to a burn within the first three hours post-injury significantly improves patient outcomes. To facilitate the integration of 20CRW into clinical practice in the United States, this investigation aimed to determine barriers and facilitators to implementing 20CRW within both prehospital Emergency Medical Services (EMS) and in-hospital emergency departments (EDs).

Methods: We used a sequential mixed methods design to identify barriers and facilitators to 20CRW implementation and co-design implementation strategies. EMS and ED clinicians completed an online questionnaire to explore perceived barriers and facilitators to delivering 20CRW. Data were coded using the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were then conducted with clinicians to co-design and tailor implementation strategies, and further explore identified barriers and facilitators to 20CRW implementation.

Findings: A total of 371 (210 EMS and 161 ED) clinicians participated in the questionnaire. Semi-structured interviews were conducted with 22 clinicians (14 EMS and 8 ED). This investigation highlighted 12 distinct determinants affecting the implementation of 20CRW into clinical practice, covering four domains of the CFIR.

Interpretation: Clinicians are highly motivated to implement 20CRW to improve outcomes for burn patients. However, a lack of resources, issues adapting 20CRW to local clinical settings, and a lack of external policies that include burn first aid cooling were identified as implementation barriers. These findings informed the co-designed 20CRW implementation strategies that will facilitate further implementation.
Original languageEnglish
PublisherSSRN
DOIs
Publication statusSubmitted - 25 Oct 2024

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