Facilitating Implementation of Evidence-Based Guidelines in Hospital Settings: Learning From Trauma Centers

This study examines issues contributing to slow and partial compliance with evidence-based clinical guidelines. It focuses on guidelines for management of severe traumatic brain injury (TBI). Because severe head trauma enlists so many providers and often involves injury to multiple body systems, it maximizes the challenges of delivering timely, consistent, and coordinated care. Management of TBI thus offers a valuable perspective on the structural problems that impede the delivery of care and the implementation of clinical guidelines. The study identifies barriers to compliance with TBI guidelines, describes how three trauma centers lowered or overcame such barriers, and identifies common threads in their approaches. Based on this analysis, the study presents a model for implementing clinical guidelines to achieve consistency, continuity, and coordination of patient care. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the author and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. This and other Fund publications are online at www.cmwf.org. To learn more about new publications when they become available, visit the Fund’s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 930.