Improving Diffusion of Clinical Care Innovations in Public Health Emergencies

The Challenge

Emergency department (ED) clinicians play a critical role in public health emergencies. During crises such as the COVID-19 pandemic, these frontline health care workers may develop new ways to evaluate and treat patients, test novel products or workflows, or adapt pre-existing care strategies for use in a new patient population. When such innovations are safe and effective, they can save lives if other clinicians can quickly learn about and adopt them, while avoiding or ceasing ineffective or harmful care practices.

Historically, however, the diffusion of medical innovations has generally been a slow process taking years if not decades. As a result, the sharing and uptake of care innovations during public health emergencies has often been chaotic, with little evidence to guide best practices for how information can best be disseminated and implemented.

What Was Missing

Previous research examined how innovations spread in health care settings during relatively steady state conditions. But few studies sought to understand how care innovations spread during public health emergencies, when clinical evidence may be limited and there is an urgent need to care for large numbers of sick patients. Given its scope and speed, the COVID-19 pandemic provided a unique opportunity to study how innovations spread on an accelerated timeline.

Our Approach

Over the course of a four-year study funded by the National Institutes of Health, RAND researchers focused on three objectives to better understand how to improve the diffusion of care innovations in ED settings during public health emergencies.

Objective 1

Understand how COVID-19 care innovations were disseminated to ED clinicians through key communication channels during the pandemic.

Core tasks included media and discourse analysis of eight target innovations and interviews with strategic disseminators.

Objective 2

Understand how clinicians found out about and implemented these innovations in hospital EDs.

Core tasks included focus group discussions with ED physicians, nurses, and respiratory therapists, and a nationwide survey of ED physicians and nurses.

Objective 3

Identify strategies and lessons learned for optimizing the diffusion of care innovations during public health emergencies.

Core tasks included identifying dissemination and implementation challenges/ facilitators and developing strategies in collaboration with an expert panel.

Strategies to Strengthen Future Dissemination of Care Innovations

As part of the third objective, researchers developed practical strategies tailored to specific groups of dissemination and implementation stakeholders—ED and health system leaders, frontline ED clinicians, clinicians influential on digital media, professional society leaders, journal and preprint editors, and state and local public health officials—to accelerate the spread and effective use of life-saving care innovations during future public health emergencies.

Strategy Documents

Additional Publications