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Table 2 Key barriers and enablers for prospectively assessing post-traumatic amnesia using a validated tool [46]

From: Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department

TDF Domains Themes
Knowledge Limited knowledge of what PTA is, how to assess it and what tools are available to assess PTA in the ED.
Environmental context and resources Mandated validated tool to assess PTA in the ED is not available in the ED. No space in the patient notes to include PTA information. ED has large workload and staff has increasing pressure to discharge patients quickly to free up beds.
Skills Limited skills and training on how to assess PTA using validated tools.
Beliefs about consequences Senior doctors do not see the additional benefits of using a validated tool to assess PTA, comfortable using their clinical experience. Using a tool to assess PTA is perceived as being more time consuming than using clinical questions and experience.
Social/professional role and identity Assessing for PTA is seen as outside the role of the ED. Unsure of who is responsible for completing and promoting use of the validated PTA tool.
Beliefs about capabilities Some ED clinicians find amnesia assessment difficult and there is inconsistency in assessment. Junior doctors find it more difficult due to their limited clinical experience. Nurses would prefer a more objective measure of amnesia and are open to the use of a validated tool.