This study examines issues contributing to slow and partial compliance with evidence-based clinical guidelines. It focuses on guidelines for management of severe traumatic brain injury (TBI). Because severe head trauma enlists so many providers and often involves injury to multiple body systems, it maximizes the challenges of delivering timely, consistent, and coordinated care. Management of TBI thus offers a valuable perspective on the structural problems that impede the delivery of care and the implementation of clinical guidelines. The study identifies barriers to compliance with TBI guidelines, describes how three trauma centers lowered or overcame such barriers, and identifies common threads in their approaches. Based on this analysis, the study presents a model for implementing clinical guidelines to achieve consistency, continuity, and coordination of patient care.
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