English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

Background Structured risk-stratification to guide clinician assessment and engagement with evidence-based therapies may reduce care variance and improve patient outcomes for Acute Coronary Syndrome (ACS). The Australian Grace Risk score Intervention Study (AGRIS) explored the impact of the GRACE Risk Tool for stratification of ischaemic and bleeding risk in ACS. While hospitals in the active arm had a higher overall rate of invasive ACS management, there was neutral impact on important secondary prevention prescriptions/referrals, hospital performance measures, myocardial infarction and 12-month mortality leading to early trial cessation. Given the Grace Risk Tool is under investigation internationally, this process evaluation study provides important insights into the possible contribution of implementation fidelity on the AGRIS study findings. Methods Using maximum variation sampling, five hospitals were selected from the 12 centres enrolled in the active arm of AGRIS. From these facilities, 16 local implementation stakeholders (Cardiology advanced practice nurses, junior and senior doctors, study coordinators) consented to a semi-structured interview guided by the Theoretical Domains Framework. Directed Content Analysis of qualitative data was structured using the Capability/Opportunity/Motivation-Behaviour (COM-B) model. Results Physical capability  was enhanced by tool  usability . While local stakeholders supported  educating frontline clinicians,  non-cardiology clinicians struggled with specialist terminology.  Physical opportunity  was enhanced by the paper-based format but was hampered when busy clinicians viewed risk-stratification as  one more thing to do , or when form  visibility  was neglected.  Social opportunity  was supported by a  culture of research/evidence  yet challenged by  clinical workflow  and  rotating medical officers .  Automatic motivation  was strengthened by  positive reinforcement .  Reflective motivation  revealed the GRACE Risk Tool as  supporting  but potentially  overriding  clinical judgment.  Divergent professional roles and identity  were a major barrier to integration of risk-stratification into routine Emergency Department practice. The cumulative result revealed  poor form completion behaviors  and a failure to embed risk-stratification into routine patient assessment, communication, documentation, and  clinical practice behaviors . Conclusions Numerous factors negatively influenced AGRIS implementation fidelity. Given the prominence of risk assessment recommendations in United States, European and Australian guidelines, strategies that strengthen collaboration with Emergency Departments and integrate automated processes for risk-stratification may improve future translation internationally.

bmc health services research

Objective risk assessment vs standard care for acute coronary syndromes—The Australian GRACE Risk tool Implementation Study (AGRIS): a process evaluation