1887
Volume 2025, Issue 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

The implementation of quality indicators (QIs) in emergency departments (EDs) is relatively limited, and the factors underlying their poor implementation remain poorly understood. This study aimed to identify and explore the barriers and facilitators to successfully implementing pediatric respiratory disease QIs in the ED from the perspective of expert panels.

A qualitative study design was conducted in March 2024, using semi-structured face-to-face interviews with a purposive sample of 13 physicians. Thematic analysis was used to identify key themes related to the barriers and facilitators of QI implementation in Jordanian ED settings.

Thematic analysis identified several key themes and subthemes regarding the barriers and facilitators of implementing pediatric respiratory disease QI initiatives in the ED. The main themes included human resources, infrastructure constraints, policy and organization, influence on quality culture, electronic health systems, documentation, and administrators. The subthemes included lack of staff, lack of QI experts, workstation issues, resource availability, data availability, time constraints, standardized guidelines, triage procedures, management, lack of QI knowledge, workforce support, education and training, automated processes, user-friendly systems, standardization, printed guidelines, awareness, legal requirements, stakeholder involvement, monitoring and feedback, and administrative support.

Successfully implementing pediatric respiratory disease QIs in ED requires addressing both key barriers and facilitators. This includes resolving infrastructure constraints, enhancing data availability through rigorous documentation, and ensuring robust administrative support. Additionally, adopting standardized forms and clear written protocols can streamline processes, while accountability measures and motivational strategies encourage the consistent implementation of QIs.

© 2025 Alkhazali, Ab Rahman, Alrawashdeh, Fauzi, licensee HBKU Press.
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2025-09-08
2025-12-05

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References

  1. Alkhazali IE, Alrawashdeh A, Hashairi Fauzi M, Nik Ab Rahman NH. Quality indicators of pediatric asthma care in the emergency department; a systematic review and meta-analysis. Arch Acad Emerg Med. 2023Feb;12:(1):e26. https://doi.org/10.22037/aaem.v12i1.2214
     [Google Scholar]
  2. Alkhazali IE, Alrawashdeh A, Hashairi Fauzi M, Nik Ab Rahman NH. Quality indicators for pediatric bronchiolitis and croup care in the emergency department; a systematic review and meta-analysis. Arch Acad Emerg Med. 2024May;12:(1):e52. https://doi.org/10.22037/aaem.v12i1.2244
     [Google Scholar]
  3. Kassam S, Serrano-Lomelin J, Hicks A, Crawford S, Bakal JA, Ospina MB. Geography as a determinant of health: health services utilization of pediatric respiratory illness in a Canadian province. Int J Environ Res Public Health. 2021Aug;18:(16):8347. https://doi.org/10.3390/ijerph18168347
     [Google Scholar]
  4. Reyes MA, Etinger V, Hronek C, Hall M, Davidson A, Mangione-Smith R, et al. Pediatric respiratory illnesses: an update on achievable benchmarks of care. Pediatrics. 2023Aug;152:(2):e2022058389. https://doi.org/10.1542/peds.2022-058389
     [Google Scholar]
  5. Cavallaro SC, Michelson KA, D’Ambrosi G, Monuteaux MC, Li J. Critical revisits among children after emergency department discharge. Ann Emerg Med. 2023Nov;82:(5):575-82. https://doi.org/10.1016/j.annemergmed.2023.06.006
     [Google Scholar]
  6. Lugo SE, Pavlicich V. Quality in triage: indicators in patients with respiratory disease. Pediatr Emerg Care. 2013Jun;29:(6):710-4. https://doi.org/10.1097/pec.0b013e3182949042
     [Google Scholar]
  7. Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: a systematic review of causes, consequences and solutions. PLoS One. 2018Aug;13:(8):e0203316. https://doi.org/10.1371/journal.pone.0203316
     [Google Scholar]
  8. Janke AT, Mangus CW, Fung CM, Kamdar N, Macy ML, Nypaver MM, et al. Emergency department care for children during the 2022 viral respiratory illness surge. JAMA Netw Open. 2023Dec;6:(12):e2346769. https://doi.org/10.1001/jamanetworkopen.2023.46769
     [Google Scholar]
  9. Hammad EA, Alabbadi I, Taissir F, Hajjwi M, Obeidat NM, Alefan Q, et al. Hospital unit costs in Jordan: insights from a country facing competing health demands and striving for universal health coverage. Health Econ Rev. 2022Feb;12:(1):11. https://doi.org/10.1186/s13561-022-00356-0
     [Google Scholar]
  10. Edwards J, Coward M, Carey N. Barriers and facilitators to implementation of non-medical independent prescribing in primary care in the UK: a qualitative systematic review. BMJ Open. 2022Jun;12:(6):e052227. https://doi.org/10.1136/bmjopen-2021-052227
     [Google Scholar]
  11. Berta W, Cranley L, Dearing JW, Dogherty EJ, Squires JE, Estabrooks CA. Why (we think) facilitation works: insights from organizational learning theory. Implement Sci. 2015Oct; 10:141. https://doi.org/10.1186/s13012-015-0323-0
     [Google Scholar]
  12. de Vos ML, van der Veer SN, Graafmans WC, de Keizer NF, Jager KJ, Westert GP, et al. Implementing quality indicators in intensive care units: exploring barriers to and facilitators of behaviour change. Implement Sci. 2010Jul;5:(1):52. https://doi.org/10.1186/1748-5908-5-52
     [Google Scholar]
  13. Zegers M, Verhage R, Hesselink G, van der Hoeven JG. Putting measurement on a diet: development of a core set of indicators for quality improvement in the ICU using a Delphi method. BMC Health Serv Res. 2022Jul;22:(1):869. https://doi.org/10.1186/s12913-022-08236-3
     [Google Scholar]
  14. Aaronson EL, Marsh RH, Guha M, Schuur JD, Rouhani SA. Emergency department quality and safety indicators in resource-limited settings: an environmental survey. Int J Emerg Med. 2015Dec;8:(1):39. https://doi.org/10.1186/s12245-015-0088-x
     [Google Scholar]
  15. Joling KJ, van Eenoo L, Vetrano DL, Smaardijk VR, Declercq A, Onder G, et al. Quality indicators for community care for older people: a systematic review. PLoS One. 2018Jan;13:(1):e0190298. https://doi.org/10.1371/journal.pone.0190298
     [Google Scholar]
  16. Anaraki NR, Mukhopadhyay M, Jewer J, Patey C, Norman P, Hurley O, et al. A qualitative study of the barriers and facilitators impacting the implementation of a quality improvement program for emergency departments: SurgeCon. BMC Health Serv Res. 2024Jul27; 24:(1):855. https://doi.org/10.1186/s12913-024-11345-w
     [Google Scholar]
  17. Matar N, Alnabhan MM. Evaluating E-health services and patients requirements in Jordanian hospitals. Int Arab J e Technol. 2014Jun;3:(4):250-7.
    [Google Scholar]
  18. Alkhazali IE, Ab Rahman NHN, Alrawashdeh A, Fauzi MH. Development of respiratory disease quality indicators for pediatric patients in Jordanian emergency departments: a RAND/UCLA appropriateness method. J Emerg Crit Care Med. 2025Mar 9:1. https://doi.org/10.21037/jeccm-24-90
     [Google Scholar]
  19. Crouch M, McKenzie H. The logic of small samples in interview-based qualitative research. Soc Sci Inf. 2006Dec;45:(4):483-99. https://doi.org/10.1177/0539018406069584
     [Google Scholar]
  20. Dicicco-Bloom B, Crabtree BF. The qualitative research interview. Med Educ. 2006Apr;40:(4):314-21. https://doi.org/10.1111/j.1365-2929.2006.02418.x
     [Google Scholar]
  21. Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015; 20:1408–16. https://nsuworks.nova.edu/tqr/vol20/iss9/3
     [Google Scholar]
  22. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:277–101. https://doi.org/10.1191/1478088706qp063oa
     [Google Scholar]
  23. Leemans K, Van den Block L, Vander Stichele R, Francke AL, Deliens L, Cohen J. How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation. Support Care Cancer. 2015Dec;23:(12):3503-11. https://doi.org/10.1007/s00520-015-2687-8
     [Google Scholar]
  24. Alexander C, Tschannen D, Argetsinger D, Hakim H, Milner KA. A qualitative study on barriers and facilitators of quality improvement engagement by frontline nurses and leaders. J Nurs Manag. 2022Apr;30:(3):694-701. https://doi.org/10.1111/jonm.13537
     [Google Scholar]
  25. Alexander CC, Tschannen D, Hays D, Clouse M, Zellefrow C, Amer KS, et al. An integrative review of the barriers and facilitators to nurse engagement in quality improvement in the clinical practice setting. J Nurs Care Qual. 2022Jan-Mar; 37:(1):94–100. https://doi.org/10.1097/ncq.0000000000000562
     [Google Scholar]
  26. Glen P, Earl N, Gooding F, Lucas E, Sangha N, Ramcharitar S. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital. BMJ Qual Improv Rep. 2015Sep;4:(1):u208191.w3260. https://doi.org/10.1136/bmjquality.u208191.w3260
     [Google Scholar]
  27. Koh J, Ahmed M. Improving clinical documentation: introduction of electronic health records in paediatrics. BMJ Open Qual. 2021Feb;10:(1):e000918. https://doi.org/10.1136/bmjoq-2020-000918
     [Google Scholar]
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Barriers and facilitators in implementing quality indicators for pediatric respiratory diseases in Jordanian emergency departments: A qualitative study
Journal of Emergency Medicine, Trauma and Acute Care 2025, 26 (2025); https://doi.org/10.5339/jemtac.2025.26
/content/journals/10.5339/jemtac.2025.26
/content/journals/10.5339/jemtac.2025.26
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  • Article Type: Research Article
Keyword(s): barriers, facilitators, pediatric emergency department, qualitative and Quality indicators

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