Journal Article

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

Vrijlandt, Sanne, Kuiper, Ruth, Ropers, Fabienne, van Wermeskerken, Anne-Marie, Oostenbrink, Rianne, van Veen, Mirjam, Ista, Erwin

2026

Overview

ObjectivesThis 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.DesignQualitative study using semistructured interviews, analysed through directed content analysis guided by the Consolidated Framework for Implementation Research (CFIR).SettingSecondary and tertiary paediatric emergency departments in three hospitals in the Netherlands.ParticipantsEighteen 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.Primary outcome measureDeterminants of Feverkidstool implementation, categorised by CFIR domains: intervention characteristics, outer setting, inner setting, characteristics of individuals and implementation process.ResultsRespondents (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.ConclusionBarriers 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.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Anti-Bacterial Agents - therapeutic use / Attitude of Health Personnel / Child / Clinical Decision-Making / Data collection / Decision making / Decision Support Systems, Clinical / Emergency Departments / Emergency medical care / Emergency Service, Hospital / End users / Female / Females / Fever - diagnosis / Fever - drug therapy / Fever - therapy / Humans / Implementation Science / Interviews / Interviews as Topic / Male / Medical research / Netherlands / Paediatric infectious disease & immunisation / Paediatrics / Pediatrics / Physicians / Qualitative Research / Teaching hospitals