Table 3 Perceived barriers and facilitators by the interview respondents
Category | Subcategory | Factor | B | F |
|---|---|---|---|---|
Intervention | Credibility | Lack of evidence [0,4,6] | ✓ | |
Utility | Lack of details in intervention description [B:1,F:1] | ✓ | ✓ | |
Advantage | Negative (B)/ positive (F) results experienced [B:6,F3] | ✓ | ✓ | |
(Not) used when (not) useful [B:4,F:3] | ✓ | ✓ | ||
(Not) used when there is (no) need [B:6,8,F:4,5,6,7,8] | ✓ | ✓ | ||
Observability | (No) positive results shown [B:8,F:7] | ✓ | ✓ | |
Feasibility | Does not work in practice [3,6,7] | ✓ | ||
Not always possible to execute [3,4] | ✓ | |||
Failed pilot test [8] | ✓ | |||
Form not user friendly [4] | ✓ | |||
Uniform policy is impossible [4] | ✓ | |||
Policy tailored to each general ward is not feasible [4] | ✓ | |||
Too many patients [7] | ✓ | |||
Implementation process | Accessibility | Intervention not converted into protocol [1] | ✓ | |
Protocol/policy available on intranet [1,2] | ✓ | |||
Clarity | Indistinct agreements surrounding intervention [4] | ✓ | ||
Support | Initiative from care professionals [4] | ✓ | ||
Creating support among healthcare professionals | ✓ | |||
Professional | Attitude | Opinion that intervention is no solution for structural problems [8] | ✓ | |
Opinion that formulating discharge criteria is (im)possible [B:1,F:1] | ✓ | ✓ | ||
Opinion that intervention is (not) useful [B:3,6,7,F:3,4] | ✓ | ✓ | ||
Negative attitude towards protocols or checklists [1,4] | ✓ | |||
Negative attitude towards new or more forms [0,4] | ✓ | |||
Negative attitude towards registration [0] | ✓ | |||
Opinion that ICU physician is involved until hospital discharge [4] | ✓ | |||
Knowledge | Guideline or intervention is unknown [1,7] | ✓ | ||
Physician has little knowledge about nursing discharge practices [3] | ✓ | |||
Awareness | Awareness of possible unsafe practices [0,5] | ✓ | ||
Behaviour | Change of routines necessary [0,4] | ✓ | ||
Skills | Lack of ICT skills [0,4] | ✓ | ||
Patient | Cognition | Communication impossible [5] | ✓ | |
Social | Leadership | Care professionals are not involved in decision making [0] | ✓ | |
Prioritization of problem/implementation of intervention [0,8] | ✓ | |||
Choices made in past [8] | ✓ | |||
Culture | (No) culture of feedback [0,4] | ✓ | ✓ | |
‘Ivory tower’-image of ICU [0] | ✓ | |||
Cultural differences between wards [4] | ✓ | |||
Collaboration | No multidisciplinary care [0] | ✓ | ||
No or too little structural consultation with ward [4] | ✓ | |||
Preconceived opinions against ICU professionals [0] | ✓ | |||
ICU nurse performs tasks in general wards [0] | ✓ | ✓ | ||
Organisational | Resources | Lack of man-hours/time [0,4,6,8] | ✓ | |
Ward physician is unavailable [4] | ✓ | |||
Ward equipment is not yet set up [4] | ✓ | |||
Lack of financial resources [8] | ✓ | |||
Structure | Large (B) or small (F) hospital [B:0,7,F:7] | ✓ | ✓ | |
ICU is ‘separated’ from hospital by architectural barriers [0] | ✓ | |||
High turnover of physicians [3] | ✓ | |||
ICT infrastructure | (No) hospital wide electronic patient file [B:4,F:4,5] | ✓ | ✓ | |
No check, no summary as a result of one electronic patient file [4] | ✓ | |||
Electronic patient file unclear/not user-friendly [5] | ✓ | |||
Intervention is connected to electronic patient file [5] | ✓ | ✓ | ||
Policy | Confusion about which physician is responsible for patient [4] | ✓ | ||
Society | Financial support | No compensation by insurance company [0,6,8] | ✓ | |
Cuts are made to minimise expenditures [8] | ✓ | |||
Confusion about financing structures [0,8] | ✓ | |||
Financial incentives | Production is central [0] | ✓ | ||
Regulations | Production instead of quality is performance measure [0] | ✓ | ||
Variation in quality of step down beds due to a lack of policy [8] | ✓ | |||
Other hospitals | Competition [7] | ✓ | ✓ | |
Professional associations | Discussion whether ICU tasks can and should be performed in general wards by ICU professionals [0] | ✓ | ||
Discussion about the reallocation of ICU tasks to general ward professionals [6] | ✓ |