Table 2 Directed content analysis of comments from panellists (disagreement rationale)
Theme | Meaning Unit | Condensed meaning unit | Category |
|---|---|---|---|
Barriers | Delayed presentation ought not be a factor in appropriate and timely fluid administration. Though I recognise access block is root cause, most crumbly or older patients probably get a bed fairly early, yet they seem not to get fluid. | Sicker patients from delayed presentations are recognised early but may not receive fluids due to individual characteristics. | Delayed presentation |
Clinicians tend to ‘customise’ care anyway or vary treatment based on the context. This is already happening I suspect. I believe the main barrier is the lack of consensus on when and how much fluid to give in sepsis. Time to antibiotics is clearer but time and amount of fluid required is not. There is confusion around fluid resuscitation in sepsis and when to introduce inotropes. I think all of this gives mixed message to clinicians | Clinical judgement supersedes sepsis guidelines in practice. | Pathway inflexibility | |
Mismatch of resources at different times is issue. I’ve waited an hour for triage and five doctors free. Never really experienced a lack of equipment | Mismatch of resources and variability between settings and professions accounts for the difference. | Lack of resources | |
Facilitators | I feel that if you have less complex patients within the department, as an ED clinician, it is quite easy to leave that patient and prioritise a patient that is unstable. Often, I find the issue is that there is a large volume of unwell patients, and then the demand is higher, making it difficult to prioritise between competing demands. Apart from trauma, we see (i.e., a smaller ED) very complex patients. Ultimately after initial assessment and treatment we then transfer these complex patients out - they still present to the ED. I do not agree - working in smaller hospitals definitely noted better patient care values. | Variations in hospital settings rather than patient’s characteristics facilitate fluid administration. | Less complex presentations |
Strategies | Alert overload, I don’t even read them anymore Do not agree - instructions still need to be carried out seamlessly with less roadblocks/steps. | Alert fatigue and poor clinical usefulness impede use of electronic alerts. | Electronic alerts |