Innovation Deimplementation in Emergency Departments During the COVID-19 Pandemic: Qualitative Study of Clinicians' Decision-Making.

Background: During a public health emergency, emergency department (ED) clinicians can improve care delivery if they identify and adopt innovations that are safe and effective. However, little is known about the factors that impact ED clinicians' decision-making around using or discontinuing innovations when evidence-based information is limited. Objective: The goal of this study was to understand the processes and factors that led ED clinicians to discontinue (deimplement) the use of COVID-19 care innovations. Methods: This is a qualitative study using semistructured focus groups with ED clinicians from 8 hospitals across the United States. Hospitals were purposively sampled and recruited to capture a diversity of perspectives based on location, facility type (academic or community hospital), rurality (urban or rural), and safety-net status. In this study, 17 physicians, 7 advanced practice providers, 18 nurses, and 7 respiratory therapists participated. We utilized both inductive and deductive techniques to perform content and thematic analysis of transcripts. Results: Clinicians shared that their own experiences (eg, direct observation of patient outcomes), contextual factors, and emerging research evidence contributed heavily to decisions about deimplementing innovations during the COVID-19 pandemic. Processes related to discontinuing innovations depended on leadership guidance and collaboration among colleagues. However, in some cases, there were no official processes to discontinue innovations, and innovations were passively deimplemented. Conclusions: Decision-making regarding the discontinuation of innovation in ED settings during the COVID-19 pandemic differed from routine conditions due to the lack of information and the rapid evolution of evidence within a short period of time. The level of evidence required to implement and deimplement innovations was significantly lower. Our findings indicate that factors influencing deimplementation during a public health emergency were highly localized and were treated similarly to pilot tests of new innovations. Future work is necessary to develop mechanisms for implementing promising innovations during evolving public health emergencies and monitoring their effectiveness and safety after implementation, enabling evidence-based decisions about whether to continue implementation or proceed with deimplementation.