Diffusion of innovations and adoption of transradial intervention.

A doption of scientific innovations, including drugs, devices, and techniques, is critical to the advancement of safe and efficacious healthcare. Often, however, disconnects between scientific evidence and clinical practice are observed with less supported innovations being widely adopted and those with stronger data underused. Popularized by the sociologist Rogers 1,2 in 1962, the diffusion of innovations theory is used to explain the spread of ideas or practices among social systems, including academic disciplines. The attractiveness of diffusion theory is that it goes beyond the innovation to understand the influence of communication channels, time, and the social system. In healthcare, adoption of a new innovation or technology depends heavily on the interaction between the innovation and the adoption system. The complexities of how an innovation is introduced into clinical practice are exemplified by the story of transradial intervention (TRI). Several aspects of TRI have contributed to the relatively slow rate of uptake in the United States. One of the main reasons that TRI has not been widely adopted is that the relative advantages of the technique, as compared with the current standard of femoral access, have not always been evident. In general, innovations that have a clear relative advantage either in effectiveness or cost-effectiveness are more often adopted. 3,4 In the 1990s, technological advances in interventional equipment allowed techniques to be performed through smaller sheaths and the feasibility of TRI was reported. 5 During the next decade, there were several pioneers who had the foresight to understand the value in TRI and develop the necessary skills to apply the technique to a broader base of patients. As a result of the efforts of the very early adopters, the procedure was not abandoned, and benefits of the technique began to emerge in the literature, including a reduction in periprocedural bleeding, cost effectiveness, and patient preference. 6 Other attributes of the innovation, however , were slowing adoption. Physicians did not have a formal way to acquire the necessary procedural skills and equipment specifically designed for radial catheterization was not available. In additional, initial studies in aggregate failed to show that TRI resulted in improved cardiovascular outcomes compared with transfemoral but did show longer fluoroscopic time and higher procedural failure. 7 The balance of the relative advantages compared with the complexity and potential risk stalled adoption of the innovation. By 2007, 14 years after the initial reports of the feasibility of TRI, only ≈1% …