Barriers and facilitators to the implementation of clinical practice guidelines in sonography

Knowledge of the size of the adult liver is an essential factor in diagnosing liver disease and in the monitoring of treatment response over time. Although there are multiple methods to determine liver size using ultrasound, currently, no clinical practice guideline exists. Recently, a reference range and equation to determine liver volume using ultrasound was developed. In order to guide the development of a clinical guideline, a scoping review was conducted in order to identify the potential barriers and facilitators to the implementation of this new measurement technique in clinical practice. A total of 40 articles were included in the review. The most commonly cited barriers to guideline adherence can be divided into categories that are related to individual barriers (knowledge and attitude) and external factors (guideline and environmental). The facilitators to overcome such barriers were also identified. It was reported that implementation is most beneficial when a range of strategies that aim to address the identified barriers are used. In conclusion, this scoping review has identified barriers and facilitators to aid in the development of interventions to improve sonographers' adherence to clinical practice guidelines in the clinical environment.