From Evidence to Practice: Implementation and Evaluation of the Discontinuation of Patient Contact Shielding in Paediatric Radiography

Abstract

INTRODUCTION: Patient contact shielding has been used in paediatric radiography as standard practice for decades. Contemporary evidence no longer supports its use in routine clinical practice. The Medical Imaging Department of an Australian quaternary paediatric hospital implemented the discontinuation of all patient contact shielding using the capability, opportunity, motivation and behaviour (COM-B) model and the theoretical domains framework (TDF). This study evaluated the implementation process with particular focus on patient, family and staff responses. METHODS: An implementation study was conducted using a mixed-methods approach, comprising retrospective analysis of imaging records (7 months pre/post implementation) and prospective collection of survey data. Implementation strategies were developed using theory-guided frameworks to address potential barriers to change. RESULTS: Retrospectively, there were 1614 examinations assessed pre-implementation and 1845 post-implementation. Pre-implementation shielding rates were 45% and 39% for male and female patients respectively. The post-implementation prospective survey component included 7581 patients, 0.4% (n = 31) of whom raised queries about the policy change. Only 11 shielding requests occurred within 5 months post-implementation, declining to zero thereafter. CONCLUSION: Theory-guided implementation was remarkably effective in translating contemporary evidence into practice. The process of removing patient shielding was achieved with minimal concern from patients and their families, contrary to expectations that this change would generate significant resistance.