Developing Evidence-Based Implementation Strategies for the Management of Women With Early Pregnancy Bleeding in the Emergency Department: A Multi-Method Study.

Objective: To determine characteristics, variability and enablers/barriers to evidence-based care and generate recommendations with implementation strategies to improve the management of early pregnancy bleeding in the emergency department (ED).

Methods: Multi-method study. Methods: This paper reports the integration phase of a multi-method study conducted in a regional health service with five sites. Quantitative results (characteristics, variabilities in care and barriers/enablers to evidence-based care) and qualitative findings (ED clinicians' perspectives and experiences) were integrated to generate new findings and recommendations, mapped to the Theoretical Domains Framework (TDF) and corresponding intervention strategies using the Behaviour Change Wheel.

Results: This study integrated findings from two cohort studies of 9859 women over 10 years and a mixed-method study of 104 ED clinicians from five sites. The four key findings were (i) ED remains a critical source of assessment, (ii) Improved access to resources is needed to provide evidence-based care, (iii) Gaps in ED clinician knowledge, skill and confidence have potential patient and health service consequences and (iv) A practice guideline is available; however, it needs refinement. These were mapped to five TDF domains: beliefs about capabilities and consequences, environmental context and resources, knowledge and skills and seven intervention functions. Recommended implementation strategies included multimodal education, clinical champions and an updated practice guideline.

Conclusions: Recommendations to improve delivery of care to women with early pregnancy bleeding in the ED focus on clinical skills and resources. An implementation strategy, considering resource availability, clinician knowledge, skills and confidence, was developed using behaviour change theory. Conclusions: Integration of characteristics, variability of, and influences on evidence-based care generated recommendations that could contribute to more consistent and effective care, improving patient and health service outcomes. No patient or public involvement.