The Respiratory Health Implementation Group (RHIG), NHS Wales, will fund publication charges for this article.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable. Welsh Government have been informed.
Availability of data and materials
The data generated and analysed during the study are available from the corresponding author upon reasonable request.
Competing interests
The authors report no competing interests.
Funding
The Welsh Government funds the Respiratory Health Implementation Group (RHIG) of which SB is the national clinical lead and RJ the programme manager. RHIG fund the Institute for Clinical Science and Technology (ICST), which create and implement a range of interventions for NHS Wales. MJP is supported by the Welsh Clinical Academic Training (WCAT) programme and a Career Development Award from the Association of Clinical Pathologists and is a participant in the NIH Graduate Partnership Program. IH is a Wellcome Trust Senior Research Fellow in Basic Biomedical Sciences. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Authors’ contributions
RJ is the primary author and member of the guideline implementation team. MJP is a secondary author and provided statistical support and advice. SB is a secondary author and clinical lead and content coordinator of the guideline. All authors have read and approved the final manuscript.
Acknowledgments
We would like to thank Welsh Government for supporting the implementation of the guideline, local HB facilitators for actively disseminated the guideline, and all healthcare workers and clinicians for the direct application of the guideline into delivering excellent quality clinical care to patients admitted into hospital within each of the HBs across Wales. Professor Chris Davies and his team at ICST who partnered with NHS Wales to successfully implement the national guideline. Dr Daniel Farewell for careful reading and statistical supervision.
Author’s information
Mr. Rhys Jefferies – [email protected]
RJ is National Programme Manager for the Respiratory Delivery Plan in Wales and is currently undertaking a PhD with Swansea University in the application of implementation science principles for a range of interventions in healthcare.
Dr. Mark Ponsford – [email protected]
MJP is supported by the Welsh Clinical Academic Training (WCAT) programme and a Career Development Award from the Association of Clinical Pathologists and is a participant in the NIH Graduate Partnership Program.
Dr. Simon Barry – [email protected]
S.B is the National Clinical Lead for Respiratory Medicine across NHS Wales and respiratory consultant in Cardiff and Vale University Health Board.
Footnotes
TIDieR checklist
1. Brief name
NHS Wales national COVID-19 Hospital (Secondary care) guideline
2. Why
At the start of the pandemic, we surmised a lack of clear guidance available would at best hinder delivery of patient care; and at worst, would lead to confusion amongst Healthcare Professionals (HCP) and inequalities in care.
We developed a hard copy single page colour poster of the guideline with a core structure and links to a web based guideline platform that hosted a range of video education, resources and COVID-Ready assessment (www.covid-19hospitalguideline.wales.nhs.uk). We targeted service-leads (consultants) who were most likely to be managing patients with COVID-19 (Respiratory, Emergency Department, Intensive Care, Palliative Care).
Once Welsh Government endorsed the intervention (guideline), we (Implementation Team) disseminated this to 18 district general hospitals across six Health Boards in Wales (appx 500 posters per hospital). Each of the Health Board Chief Operating Officers selected guideline facilitators. Facilitators were on-boarded to the guideline facilitator dashboards to provide registration and activity data and dissemination tools to increase spread. Once registered with emails, HCPs were provided frequent email updates from leading clinicians from across NHS Wales. A dedicated implementation support team supported the guideline facilitators.
3. Who provided
The Implementation Team consisted of the National Clinical Lead for Respiratory Medicine (S.B), the programme manager for the national respiratory delivery plan for NHS Wales (R.J) who is currently completing his thesis in implementation science in healthcare, and members of Welsh Government policy team. The guideline facilitators were provided individual training and on-boarding how to use their dashboards by implementation support team.
4. How
The guideline was disseminated in hard copy format across each DGH in Wales, with further awareness activity generated through social media activity, executive meetings, presentations, and targeted facilitator activity. This was provided mostly to groups.
5. Where
The guideline was implemented within 18 DGH’s across six Health Boards in Wales during the first wave of the COVID pandemic.
6. When and how much
The guideline was published and dissemination initiated around the 22nd of March 2020. The guideline remains available now during the second wave.
7. Tailoring
The fixed core component of the guideline did not change as this was structural and would cause confusion should hard copies of the guideline be in existence on walls across the hospitals. However, the QR links underwent 18 changes as new evidence emerged or new instruction required. The clinical governance team agreed changes and updates to the guideline were notified to registrants via email, and QR links.
8. Modifications
See above. The changes were clinical instruction pertaining to the relevant step on the guideline.
9. How well
A COVID-Ready assessment was available to all registrants. Passing the assessment provided a fidelity tool to ensure registrants not only understood the latest guidance, but also the mechanism and expectations of the guideline methodology. One of the key roles of the facilitator was to recommend registrants undertake the COVID-Ready assessment, upon which they would receive a COVID-Ready certificate. One HB mandated that all registrants complete the assessment, which increased assessment activity significantly.
A registrant survey also explored the extent to which the guideline was used and to what degree this influenced their clinical practice.