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Table 3 Perceived barriers and facilitators by the interview respondents

From: Barriers and facilitators to improve safety and efficiency of the ICU discharge process: a mixed methods study

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]  
  1. […] = interventions to which the factor is applicable; 0 = General; 1 = Dutch Intensive Care Society (NVIC) guideline; 2 = ICU discharge policies; 3 = Early discharge planning; 4 = Communication at handover; 5 = Medication reconciliation; 6 = Consulting ICU nurse; 7 = Monitoring of post-ICU patients; 8 = Step down beds
  2. Abbreviations: B Barrier, F Facilitator