Table 3 Results of CFIR-ERIC implementation mapping to identify key strategies to address barriers to ED-based AMI care in Tanzania
CFIR Construct | Key Barrier(s) | Implementation strategy |
|---|---|---|
Complexity | Providing timely and evidence-based AMI care would require substantial changes to current ED operations | (No Level 1 strategy) |
Cost | High-quality AMI care requires substantial hospital investments in expensive diagnostic equipment, treatments, staff, and other infrastructure. | Access new funding |
Culture | Some participants perceive a lack of urgency, motivation, or attention to detail among ED staff when caring for AMI patients. | Identify and prepare champions |
Available resources | Many EDs do not have adequate staff, diagnostic equipment, and treatment capacity to care for AMI patients. | Access new funding |
Access to knowledge and information | Many ED providers lack adequate training in the diagnosis and treatment of AMI. | Conduct educational meetings; develop educational materials; distribute educational materials |
Knowledge and beliefs about the innovation | Many patients lack basic understanding of AMI, both before and after their diagnosis. | Conduct educational meetings |
Formally appointed internal implementation leaders | A formal leader is needed to supervise an AMI quality improvement initiative. | Identify and prepare champions |
Champions | Multiple staff members are needed to encourage the care team to commit to improving AMI care. | Identify and prepare champions |
Execution | EDs sometimes fail to provide high-quality AMI care, even when diagnostic and treatment capacity is available. Providers sometimes do not communicate effectively with AMI patients or counsel them. ED systems of care and patient flow processes are sometimes inefficient. | (No Level 1 strategy) |