Evidence-based implementation of evidence-based guidelines.

Purpose: There is evidence that some strategies for guideline implementation are more successful than others. This paper aims to describe the process of developing an evidence-based guideline implementation strategy for use in rural emergency departments.

Design/methodology/approach: Participation in a nationally funded, research fellowship program involved attendance at workshops run by internationally renowned experts in the field of knowledge translation. Attendance at these workshops, associated reading and a literature review allowed those implementation strategies with the most supportive evidence of effectiveness to be determined.

Findings: A multi-faceted implementation strategy was developed. This strategy involved the use of an implementation team as well as addressing issues surrounding individual clinicians, the "emergency department team", the physical structure and processes of the ED and the culture of the department as a whole. Reminders, audit and feedback, education, the use of opinion leaders, and evidence-based formatting of guidelines were all integral to the process.

Practical implications: It is postulated that an evidence-based implementation strategy will lead to greater changes in clinician behaviour than other strategies used in quality improvement projects.

Originality/value: This is an important article as it describes the concept and development of evidence-based interventions, which, if tailored to the individual hospital (as evidence-based medicine is tailored to the individual patient), has the potential to improve compliance with clinical guidelines beyond that achieved with most QI projects.