Implementation and Evaluation of a Hospital-Wide Gout Protocol

Abstract

A systematic case-file clinical review carried out at Liverpool Hospital, Australia reported sub-optimal management of acute gout occurring during hospitalization, resulting in poor clinical outcomes. To improve patient care, we developed a new hospital-wide gout protocol to inform decision making regarding investigations, management, and referrals to Rheumatology. To maximise adoption of this protocol by non-rheumatologists, we sought to develop and employ evidence-based implementation strategies for the distribution of the new protocol, and to evaluate the effectiveness of this implementation. A literature review indicated that the strongest strategy is a form of continual reminder system, while use of opinion leaders and passive sessions such as lectures and seminars were less effective. A baseline survey of hospital medical staff supported the need for a new protocol, and a multi-factorial implementation approach was adopted that included computerised and paper reminders, interactive education sessions, and an audit and feedback process to be completed in the near future. An evaluation survey after four months revealed that the interactive education sessions were rated most effective by clinicians. While the automated reminders did not rate as highly with clinicians at this stage, they are likely to become a more significant distribution tool over an extended period. A repeat case-file review is planned and should be a true indicator of the success of the protocol in improving professional practice and patient outcomes.