Table 2 Implementation strategy categorisation and determination of whether it was costed in the included paper

Use evaluative & iterative strategies

Assess for readiness and identify barriers and facilitators

A multidisciplinary team of key informants at National Paediatric Oncology (UNOP) established paediatric early warning system (PEWS) implementation was feasible based on long-term institutional dedication to quality improvement, strong nursing buy-in for the project and paediatric intensive care unit (ICU) commitment to improving outreach and monitoring in the hospital wards

(From former paper [32]) [24]

N

Before the implementation, the current situation (organisational aspects of the medical ward, procedures and processes) was assessed

(From former paper [33]) [31]

Y

Audit and provide feedback

Monthly reports on clinician’s transfusion practices

[28]

Y

Provision of real-time physician feedback

[23]

Y

Conduct cyclical small tests of change

Two physicians from the medical group reviewed all messages generated by the system for 4 months prior to implementation and suggested modifications directed at ensuring that messages would be perceived as necessary, useful and brief

[26]

Y

Develop a formal implementation blueprint

Both hospitals had a systematic approach for the implementation of computerised provider order entry (CPOE)

(From former paper [33]) [31]

Y

Develop and organise quality monitoring system

At the end of PEWS implementation, compliance with PEWS performance and documentation was 100%

(From former paper [32]) [24]

N

Review of noncompliant cases from the clinical data abstraction

[23]

Y

Purposely re-examine the implementation

The implementation team evaluated the implementation process in a session at each ward with physicians and nurses

(From former paper [33]) [31]

Y

Nurse educator: responsible for monitoring of PEWS quality

[24]

Y

Stage implementation scale-up

A commercial patient data management system (PDMS) was introduced stepwise in each ICU subarea to replace the former paper-based patient chart

[25]

Y

After a successful pilot, the PEWS system was implemented unit by unit in all non-paediatric ICU inpatient areas over a 6-month period

(From former paper [32]) [24]

N

CPOE/CDSS was not simultaneously implemented in all study wards

(From former paper [33]) [31]

Y

CPOE system was implemented incrementally over 2 years

[27]

Y

Rollout from 2005 to 2011

[29]

Y

Provide interactive assistance

Centralise technical assistance

A member of the electronic patient record (EPR) staff was responsible for implementing it on the EPR system

[28]

Y

Centralised IT staff required to maintain the PDMS

[25]

N

Annual ongoing costs included help desk support

[30]

Y

Ongoing help desk support. The help desk was staffed by one technical person and two clinical pharmacists who specialised in CPOE implementation

[27]

Y

Provide clinical supervision

Full-time sepsis programme coordinator.

[23]

Y

Nurse educator: responsible for on-the-ground support

[24]

Y

Transfusion practitioner (TP) feeds back monthly reports on clinician’s transfusion practices in team meetings where open discussion is promoted to share experiences and as part of the education aspect of the meeting

[28]

Y

Provide local technical assistance

During the actual implementation, the implementation team was available to answer questions and solve problems

(From former paper [33]) [31]

Y

Train & educate stakeholders

Conduct education meetings

Feedback reports on clinician’s transfusion practices discussed at monthly team meetings with education provided

[28]

Y

Conduct ongoing training

Annual clinical personnel training

[29]

Y

Conduct ongoing MD training & nursing skills fair

[23]

Y

Personnel costs reflect … training

[27]

Y

Training of nurses: initial 30-min training workshop & retraining exercises (6-h total)

Nurse educator: responsible for PEWS training

[24]

Y

Training of pharmacists and nurses

[30]

Y

Training of physicians

[30]

N

Training of physicians

[24]

N

Training provided by TP: 30-min training sessions for new junior doctors on how to use the system

[28]

Y

Physicians and nurses were introduced to and trained in the use of the system

(From former paper [33]) [31]

Y

Develop educational materials

Develop physician/nurse training material

[23]

Y

Training materials

[24]

Y

Distribute educational materials

Pocket sepsis reference cards for nurses and doctors at the ED department

[23]

Y

Make training dynamic

This introduction was different in both hospitals: demonstrations in one (passive learning) versus real practicing in prescribing (active learning) in the other

(From former paper [33]) [31]

Y

Use train-the-trainer strategies

Building a clinical support team (train the trainer)

[30]

Y

Training may have a ripple effect

[28]

N

Develop stakeholder interrelationships

Identify and prepare champions

Nurse educator

[24]

Y

Physician champion

[30]

Y

Use of TP as a champion

[28]

Y

Involve executive boards

Executive committee to implement policies and procedures set forth by the steering committee

[23]

Y

Model and simulate change

The modified PEWS was first piloted in the intermediate care unit at UNOP. During the pilot, we focused on identifying problems with the tool and making the necessary adjustments

(From former paper [32]) [24]

N

Personnel costs: testing

[27]

Y

Testing of the electronic medication management system (eMMS)

[29]

Y

Use advisory boards and workgroups

A multidisciplinary team implemented a modified PEWS

[24]

N

Sepsis steering committee: reviews sepsis cases and sends out timely weekly feedback, reviews and approves physician and nursing educational material and works with epic IT team to create new navigators, warning systems and order sets to improve recognition and management of sepsis

[23]

Y

Use an implementation advisor

Research personnel (assuming researcher is an implementation scientist)

[23]

N

Adapt & tailor to the context

Promote adaptability

Involving physicians, pharmacists and nurses in the revision process.

[26]

Y

Configuration of commercial CDSS (MedChart)

[29]

Y

Modified the PEWS tool and algorithm from Boston Children’s Hospital for use at UNOP

(From former paper [32]) [24]

N

Technical adjustments were made

(From former paper [33]) [31]

Y

TP was involved in the design of the CDSS

[28]

Y

Tailor strategies

Once the fully revised system was ready to go live, a memo was sent to the medical group’s providers to inform them of the new messages they would be receiving. The group had a history of including locally developed alerts and messages within their electronic medical records system so no further training was necessary

[26]

Y

Support clinicians

Create new clinical teams

The implementation process was performed by an implementation team consisting of information and communication technology and hospital pharmacy staff

(From former paper [33]) [31]

Y

Facilitate relay of clinical data to providers

Monthly reports on clinician’s transfusion practices

[28]

Y

Provision of real-time physician feedback

[23]

Y

Utilise financial strategies

Access new funding

Investment costs are covered by a hospital-wide PDMS implementation budget and derived from a separate PDMS investment plan for university hospitals with funding from the German government

[25]

N

Financial incentives from the Centers for Medicare & Medicaid Services to providers who demonstrate meaningful use. At the top of the list of stage 1, meaningful use criteria are implementation of the CPOE system

[27]

Y

Alter incentive/allowance structures

When the Everett Clinic meets prespecified quality benchmarking criteria, the pay-for-performance incentives are awarded annually by the health plans with which it contracts

[27]

Y

Change infrastructure

Mandate change

Executive committee to implement policies and procedures set forth by the steering committee

[23]

Y

The boards of directors of both hospitals enforced their medical wards to implement CPOE

(From former paper [33]) [31]

Y

Other

Workflow alterations

Before the implementation, the current situation (organizational aspects of the medical ward, procedures and processes) was assessed

(From former paper [33]) [31]

Y

Executive committee to implement policies and procedures set forth by the steering committee

[23]

Y

Prescribing at the point of care demanded a fundamental shift in workflow

[27]

N

Implementation also involved modification of nursing flowsheets to allow PEWS documentation and PEWS colour coding (green, yellow or red) on all unit census boards

(From former paper [32]) [24]

N

Updating of hospital protocols and guidelines

[29]

Y

Workflow-related issues

[30]

N