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Innovation adoption, use and implementation in emergency departments during the COVID-19 pandemic
  1. Shreya S Huilgol1,
  2. Carl T Berdahl2,3,
  3. Nabeel Qureshi2,
  4. Catherine C Cohen2,
  5. Peter Mendel2,
  6. Shira H Fischer1
  1. 1RAND Corporation, Boston, Massachusetts, USA
  2. 2RAND Corporation, Santa Monica, California, USA
  3. 3Departments of Medicine and Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  1. Correspondence to Shreya S Huilgol, RAND Corporation, Boston, Massachusetts, USA; shuilgol{at}


Introduction During a public health emergency like the COVID-19 pandemic, emergency department (ED) clinicians may be able to save more lives if they rapidly identify and implement innovations that are safe and effective. However, there is little research examining clinician decision-making around innovation implementation during public health emergencies and when evidence-based information is limited.

Objective The goals of this study were to understand how ED clinicians decided to implement innovations and to describe the facilitators and challenges they faced during implementation.

Methods We conducted 3 pilot interviews and 13 focus group discussions with clinicians from eight hospital-based EDs across the USA. Seventeen physicians, seven advanced practice providers, 18 nurses and seven respiratory therapists participated. We used inductive and deductive techniques to perform content and thematic analysis of focus group transcripts.

Results Participants cited social media, clinician autonomy, limited resources, organisational culture, supportive leadership and outside experiences as facilitators of trying innovations. Challenges in trying new innovations included limited evidence-based information, evolving guidelines, fear, moral distress and clinician pushback. Facilitators of using innovations in practice included leadership advocating for continued use, signs of patient improvement, ease of adoption and adequate resources. Challenges were the lack of familiarity, no established protocol and limited information dissemination about best practices.

Conclusion Our study highlights factors that influenced innovation adoption and implementation in EDs during the COVID-19 pandemic, including how fear and moral distress affected decision-making. Organisations can support the implementation of promising innovations by selecting strong leaders, ensuring clinician psychological safety, providing protocols and resources and highlighting successes.

  • Emergency Medicine
  • Health services research
  • COVID-19

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  • Contributors SH had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: CB, PM, SF. Acquisition of data: SH, CB, NQ, CC, PM, SF. Analysis and/or interpretation of data: SH, CB, NQ, CC, SF. Preparation of the manuscript: SH, NQ. Supervision: CB, CC, SF, PM. All authors approved the final manuscript.

  • Funding This study was supported by the National Institutes of Allergy and Infectious Diseases, within the National Institutes of Health, an agency of the United States Department of Health and Human Services (NIAD5R01AI169293).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.