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Knowledge-to-action cycle
  1. Sharon E Straus,
  2. Jayna Holroyd-Leduc
  1. University of Calgary; Calgary, Alberta, Canada

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    Healthcare systems worldwide are faced with improving quality of care and decreasing adverse events.1 Providing evidence from clinical research is necessary but not sufficient for the provision of optimal care.2 This finding has created interest in knowledge translation (KT), the scientific study of the methods for closing the knowledge-to-practice gap and the analysis of barriers and facilitators inherent in this process.2 There are many proposed theories and frameworks for achieving KT, which can be confusing.3 One conceptual framework developed by Graham et al builds on the commonalities found in an assessment of planned-action theories.4 This knowledge-to-action cycle (figure) comprises knowledge creation and action components. We describe the application of this knowledge-to-action framework to a common clinical challenge: preventing delirium in older adults hospitalised for hip fracture.

    Knowledge-to-action cycle

    THE PROBLEM

    Delirium occurs in 25–65% of hospitalised patients treated for acute hip fracture.5-7 These patients are at increased risk of death, longer hospital stay, hospital-acquired complications, persistent cognitive deficits, and discharge to long-term care.8-11 Several factors increase the risk of delirium, including older age, use of physical restraints, malnutrition, use of urinary catheters, and the addition of more than 3 new medications.12

    Strategies to prevent delirium have been shown to be effective but are underused in practice. Since multiple factors usually contribute to the development of delirium, multicomponent interventions appear effective in its prevention.13 14 A Cochrane review of strategies to prevent delirium15 identified 1 study of a multicomponent intervention targeted towards older adults admitted with hip fractures.16 However, multicomponent interventions are challenging to implement and sustain in real world clinical settings. One strategy to …

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