Public Health in the Emergency Department: Overcoming Barriers to Implementation and Dissemination

Authors

  • Mary Pat McKay MD, MPH,

    1. From the Center for Injury Prevention and Control and the Department of Emergency Medicine, The George Washington University (MPM), Washington, DC; the Center for Trauma and Injury Prevention Research and the Department of Emergency Medicine, University of California (FEV), Irvine, CA; the University of Texas at Austin and the Screening and Brief Intervention Program, University Medical Center at Brackenridge (CF), Austin, TX; and the Division of Emergency Care Policy & Research, Department of Emergency Medicine, School of Medicine and School of Social Policy & Practice, University of Pennsylvania (KR), Philadelphia, PA.
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  • Federico E. Vaca MD, MPH,

    1. From the Center for Injury Prevention and Control and the Department of Emergency Medicine, The George Washington University (MPM), Washington, DC; the Center for Trauma and Injury Prevention Research and the Department of Emergency Medicine, University of California (FEV), Irvine, CA; the University of Texas at Austin and the Screening and Brief Intervention Program, University Medical Center at Brackenridge (CF), Austin, TX; and the Division of Emergency Care Policy & Research, Department of Emergency Medicine, School of Medicine and School of Social Policy & Practice, University of Pennsylvania (KR), Philadelphia, PA.
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  • Craig Field PhD, MPH,

    1. From the Center for Injury Prevention and Control and the Department of Emergency Medicine, The George Washington University (MPM), Washington, DC; the Center for Trauma and Injury Prevention Research and the Department of Emergency Medicine, University of California (FEV), Irvine, CA; the University of Texas at Austin and the Screening and Brief Intervention Program, University Medical Center at Brackenridge (CF), Austin, TX; and the Division of Emergency Care Policy & Research, Department of Emergency Medicine, School of Medicine and School of Social Policy & Practice, University of Pennsylvania (KR), Philadelphia, PA.
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  • Karin Rhodes MD, MS

    1. From the Center for Injury Prevention and Control and the Department of Emergency Medicine, The George Washington University (MPM), Washington, DC; the Center for Trauma and Injury Prevention Research and the Department of Emergency Medicine, University of California (FEV), Irvine, CA; the University of Texas at Austin and the Screening and Brief Intervention Program, University Medical Center at Brackenridge (CF), Austin, TX; and the Division of Emergency Care Policy & Research, Department of Emergency Medicine, School of Medicine and School of Social Policy & Practice, University of Pennsylvania (KR), Philadelphia, PA.
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  • Dr Rhodes is supported in part by K23 MH64572.

  • This work is the output from a consensus workshop conducted during the May 2009 AEM Consensus Conference in New Orleans, LA: “Public Health in the ED: Surveillance, Screening, and Intervention.”

  • The authors thank the following people who participated in our discussion at the consensus conference (alphabetical order): Suleman Ahmed, Betty Chang, Kit Delgado, Gary Green, Marna Greenberg, Toni Guess, Dave Holson, Brooke Hoots, Robin Ikeda, Chris Kahn, Judy Linclen, Joan M. Miller, Mary Murphy, Carla Pruden, and Kathryn Wells.

Address for correspondence and reprints: Mary Pat McKay, MD, MPH; e-mail: mmckay@mfa.gwu.edu.

Abstract

This article is the outcome of a consensus building workshop entitled, “Overcoming Barriers to Implementation and Dissemination” convened at the 2009 Academic Emergency Medicine Consensus Conference, ‘‘Public Health in the ED: Surveillance, Screening, and Intervention.” The participants were asked to address potential methods for overcoming barriers to the dissemination and implementation in the emergency department (ED) of evidenced-based practices to improve public health. The panel discussed three broad areas of interest including methods for disseminating evidence-based practices, barriers encountered during the process of implementation, and the importance of involvement in activities outside the ED including engagement in policy development and improvement. Four recommendations were discussed in detail and consensus was reached. The recommendations included 1) researchers and advocates should disseminate findings through multiple forums beyond peer-reviewed publications when an ED-based public health intervention has enough evidence to support integration into the routine practice of emergency care; 2) local barriers to implementation of public health interventions should be recognized and well understood from multiple perspectives prior to implementation; 3) innovation must be put into place and adapted based on local institutional context and culture as barriers and the best methods for overcoming them will vary across institutions; and 4) use of legislation, regulation, and incentives outside of the ED should support and strengthen ED-based interventions. For each area of interest, research dimensions to extend the current understanding of methods for effectively and efficiently implementing evidence-based public health interventions in the ED were discussed and consensus was achieved.

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