• Charlotte Mary Alexander, Eve Purdy, Aoife Reynolds, Luc Nguyen, Richard Af Pellatt, and Gerben Keijzers.
• Emergency Department, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
• Emerg Med Australas. 2024 Apr 16.

ObjectiveTo understand the reach, adoption and implementation of the evidence that buddy strapping for uncomplicated fifth metacarpal neck fractures is non-inferior to plaster casting.MethodsMixed-method study using clinical audit of the years before and after the original randomised controlled study was published (2019) and staff questionnaires/semi-structured interviews.ResultsSixty-nine percent of questionnaire respondents were aware of the original study findings (i.e. reach) and 57% had adopted the research findings. The proportion of patients receiving buddy strapping was 6% in 2014-2016 and 28% in 2019-2021 (implementation). Qualitative data provided insight into ongoing barriers to adoption and implementation including fear of reprisal, the need for permission, opinions of senior decision makers, perceptions about patient preferences, and an overall tendency to 'play it safe'.ConclusionsEven in a department where primary research is conducted, implementation requires ongoing attention to factors impacting reach and adoption.© 2024 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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