ArticleInternational journal for quality in health care : journal of the International Society for Quality in Health Care2026
The intent is good but… exploring barriers and enablers to clinical pathway use in regional Australian Emergency Departments.
Article in International journal for quality in health care : journal of the International Society for Quality in Health Care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
6 authors.
Funding
Abstract
backgroundClinical pathways can improve the quality, safety, and efficiency of care, but their integration into routine emergency department (ED) practice remains challenging. Factors influencing pathway use, particularly organizational and contextual determinants, are often overlooked, despite their importance for successful implementation and sustainability. These challenges may be amplified in regional EDs facing workforce and resource constraints. This study examined the barriers and enablers influencing the use of fractured neck of femur (NOF) and suspected stroke pathways in regional Australian EDs to inform service improvement and pathway redesign.
methodsA qualitative exploratory study was conducted across regional EDs in Tasmania. The study utilized big picture mapping workshops and semistructured interviews to examine pathway use in real‑world clinical settings. Twenty-five clinicians participated in three multidisciplinary mapping workshops, and 14 clinicians took part in in‑depth interviews. Mapping identified key steps and decision points within fractured NOF and stroke pathways, while interviews explored clinicians' experiences and perceptions. Data were deductively analysed using the updated Consolidated Framework for Implementation Research (CFIR).
resultsMapping revealed common care processes but significant site-level differences, including inconsistent pathway initiation. Interviews revealed that pathway use was influenced by factors across CFIR domains: complexity and workflow misalignment were barriers, with digital integration a valued enabler (Innovation). Time pressures and resource limitations affected pathway use (Outer setting). Leadership buy‑in and champions enabled use (Inner setting). Clinicians expressed concern about diminishing clinical judgement (Individuals domain), while Implementation process domain barriers included limited collaboration.
conclusionPathway use in Tasmanian EDs is influenced by barriers and enablers across CFIR domains. Simplifying pathways and ensuring adaptability were perceived to improve usability, while misaligned workflows and paper-based processes hinder uptake. Addressing resource constraints, fostering leadership engagement, and strengthening education are essential. Embedding planning, collaboration, and feedback will ensure pathways remain practical, evidence-based, and deliver timely, standardized care.
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