Authors: (including presenting author): :
Lam RPK(1)(2), Hung KKC(3)(4), Lui CT(5), Kwok WS(6), Lam WWT(7), Lau EHY(7), Sridhar S(8), Tsang TC(2), Graham CA (3)(4), Rainer TH(1)(2)
Affiliation: :
(1)Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong (2)Accident and Emergency Department, Queen Mary Hospital (3)Accident & Emergency Medicine Academic Unit, The Chinese University of Hong Kong (4)Accident and Emergency Department, Prince of Wales Hospital (5)Accident and Emergency Department, Tuen Mun Hospital (6)Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital (7)School of Public Health, The University of Hong Kong (8)Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong
Keyword 2: :
Emergency departments
Keyword 3: :
Implementation sciences
Keyword 4: :
Qualitative research
Introduction: :
To standardize sepsis care in the emergency department (ED) and improve the uptake of the Surviving Sepsis Campaign Hour-1 Bundle, we propose a novel sepsis care model (NEWS-1 care), in which a National Early Warning Score 2 ≥5 triggers the Hour-1 Bundle.
Objectives: :
We aimed to identify the implementation barriers and facilitators of the NEWS-1 care/Hour-1 Bundle in multiple EDs in Hong Kong.
Methodology: :
In the pilot type 1 hybrid trial, we evaluated the implementation of NEWS-1 care using mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Two rounds of focus group interviews (pre/post-patient enrolment period) and an anonymous staff survey were conducted. Grounded theory was used to analyze qualitative data, with independent coding and thematic analysis by two coders using NVivo version 14. Qualitative data from interviews were triangulated and interpreted with quantitative survey data.
Result & Outcome: :
Focus group interviews involving 48 ED doctors and nurses, and staff surveys with 116 respondents identified multiple implementation barriers and facilitators of the NEWS-1 care. From the interviews, 187 codes generated from the transcript verbatim were synthesised into 28 main themes and categorised as barriers and facilitators under the RE-AIM framework. Barriers to care bundle implementation involved every bundle component. NEWS2 calculation was identified as a barrier in adoption, implementation, and maintenance of the NEWS-1 care, with doubts about the appropriateness of the cutoff point. Increasing NEWS2 uptake through automatic score calculation, streamlining delivery of bundle components, breaking staff inertia, and designated resources for sepsis might facilitate its ED implementation. Conclusions Many of the implementation barriers and facilitators of the NEWS-1 care are local issues, but some are universal. This information is useful to inform initiatives seeking to improve ED sepsis care.
