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

## TL;DR

This study explores what helps or hinders the use of a tool to guide fever management in children at emergency departments in the Netherlands.

## Contribution

The study identifies specific barriers and facilitators to implementing the Feverkidstool in emergency departments using the CFIR framework.

## Key findings

- The Feverkidstool's evidence-based guidance and potential to reduce antibiotic use were seen as valuable.
- User-friendliness was a facilitator, while the need for CRP testing and lack of EHR integration were barriers.
- Standardizing care for febrile children was considered a key benefit of the tool.

## Abstract

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.

Qualitative study using semistructured interviews, analysed through directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR).

Secondary and tertiary paediatric emergency departments in three hospitals in the Netherlands.

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.

Determinants of Feverkidstool implementation, categorised by CFIR domains: intervention characteristics, outer setting, inner setting, characteristics of individuals and implementation process.

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.

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.