{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:31:36Z","timestamp":1793302296189,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Medical Research Future Fund","award":["MRF2018041"],"award-info":[{"award-number":["MRF2018041"]}],"id":[{"id":"https:\/\/ror.org\/0513v5k17","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 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\u2011world clinical settings. Twenty-five clinicians participated in three multidisciplinary mapping workshops, and 14 clinicians took part in in\u2011depth interviews. Mapping identified key steps and decision points within fractured NOF and stroke pathways, while interviews explored clinicians\u2019 experiences and perceptions. Data were deductively analysed using the updated Consolidated Framework for Implementation Research (CFIR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mapping 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\u2011in and champions enabled use (Inner setting). Clinicians expressed concern about diminishing clinical judgement (Individuals domain), while Implementation process domain barriers included limited collaboration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pathway 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/intqhc\/mzag153","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:14:21Z","timestamp":1789989261000},"source":"Crossref","is-referenced-by-count":0,"title":["<i>The intent is good but\u2026<\/i>\n                    exploring barriers and enablers to clinical pathway use in regional Australian Emergency Departments"],"prefix":"10.1093","volume":"38","author":[{"given":"Innocent Tawanda","family":"Mudzingwa","sequence":"first","affiliation":[{"name":"Tasmanian School of Medicine, University of Tasmania , Hobart,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phoebe","family":"Griffin","sequence":"additional","affiliation":[{"name":"Tasmanian School of Medicine, University of Tasmania , Launceston,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Tavender","sequence":"additional","affiliation":[{"name":"Emergency Research Group, Murdoch Children\u2019s Research Institute (MCRI), Melbourne ,","place":["Australia"]},{"name":"Departments of Paediatrics and Critical Care, University of Melbourne, Melbourne ,","place":["Australia"]},{"name":"Faculty of Health Sciences, Australian Catholic University , Melbourne,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giles","family":"Barrington","sequence":"additional","affiliation":[{"name":"Royal Hobart Hospital, Hobart, Tasmania Health Service ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viet","family":"Tran","sequence":"additional","affiliation":[{"name":"Tasmanian School of Medicine, University of Tasmania , Hobart,","place":["Australia"]},{"name":"Royal Hobart Hospital, Hobart, Tasmania Health Service ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah Jane","family":"Prior","sequence":"additional","affiliation":[{"name":"Tasmanian School of Medicine, University of Tasmania , Burnie,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026102914472910000_mzag153-B1","doi-asserted-by":"publisher","first-page":"CD006632","DOI":"10.1002\/14651858.CD006632.pub3","article-title":"Clinical pathways for secondary care and the effects on professional practice, patient outcomes, length of stay and hospital costs","volume":"5","author":"Rotter","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"2026102914472910000_mzag153-B2","doi-asserted-by":"publisher","first-page":"11786329251328527","DOI":"10.1177\/11786329251328527","article-title":"The use of clinical pathways in emergency departments: a scoping review","volume":"18","author":"Mudzingwa","year":"2025","journal-title":"Health Serv Insights"},{"key":"2026102914472910000_mzag153-B3","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1177\/2053434517732507","article-title":"Are emergency department CP interventions adequately described, and are they delivered as intended? 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