Identifying facilitators and barriers to implementing the Feverkidstool, a clinical decision tool, in the emergency department: a qualitative study in the Netherlands

BMJ Open, vol. 16, pp. e106788

Abstract

OBJECTIVES: This study aimed to identify determinants that hinder or facilitate implementation of the Feverkidstool, a clinical decision support tool offering a quantitative, evidence-based approach, to manage children with fever in the emergency department (ED) setting. DESIGN: Qualitative study using semistructured interviews, analysed through directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR). SETTING: Secondary and tertiary paediatric emergency departments in three hospitals in the Netherlands. PARTICIPANTS: Eighteen potential end users of the Feverkidstool, including paediatricians and paediatric residents working in the ED and involved in the care of febrile children, participated in the study. PRIMARY OUTCOME MEASURE: Determinants of Feverkidstool implementation, categorised by CFIR domains: intervention characteristics, outer setting, inner setting, characteristics of individuals and implementation process. RESULTS: Respondents (n=18) perceived the evidence-based guidance by the Feverkidstool and its potential to reduce antibiotic use as valuable. However, concerns were raised about its applicability to critically ill children and those with comorbidities. User-friendliness was seen as a facilitator, whereas the need for C reactive protein testing and lack of integration with electronic health records were mentioned as barriers. The ability to standardise care for febrile children was considered an important benefit of using the Feverkidstool. CONCLUSION: Barriers and facilitators across all CFIR domains are identified. Addressing these will facilitate implementation. When effectively implemented, the Feverkidstool has the potential to improve care for children presenting with fever in the ED. This may potentially lead to a more standardised approach and reduce unnecessary antibiotic prescriptions.

Authors 6

1. Sanne Vrijlandt

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of General Pediatrics, Erasmus MC Sophia, Rotterdam, The Netherlands

2. Erwin Ista

   Erasmus MC · Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of Internal Medicine, Erasmus MC Universitair Medisch Centrum Rotterdam, Rotterdam, The Netherlands

   Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Childrens Hosp, Rotterdam, The Netherlands

3. Ruth Kuiper

   Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of General Pediatrics, Sophia Children’s Hospital, Rotterdam, The Netherlands

4. Anne‐Marie van Wermeskerken

   Flevoziekenhuis

   Affiliation as printed

   Department of Pediatrics, Flevoziekenhuis, Almere, The Netherlands

5. Fabienne G. Ropers Aachen Pediatrics

   Leiden University Medical Center

   Affiliation as printed

   Pediatrics, Leiden Universitair Medisch Centrum, Leiden, The Netherlands

6. Rianne Oostenbrink corresponding

   Erasmus MC - Sophia Children’s Hospital

   Affiliation as printed

   Department of General Pediatrics, Sophia Children’s Hospital, Rotterdam, The Netherlands