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Implementing Rapid Whole-Genome Sequencing in Critical Care: A Qualitative Study of Facilitators and Barriers to New
Linda S Franck1, Rebecca M Kriz2, Seema Rego3
1Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA.
Insights
Implementing rapid whole-genome sequencing (rWGS) for critically ill children requires champions, education, and clear workflows. Understanding team perspectives is key for successful adoption of this technology in pediatric critical care.
Area of Science:
- Genomics
- Pediatric Critical Care
- Implementation Science
Background:
- Rapid whole-genome sequencing (rWGS) offers potential for diagnosing critically ill children.
- Implementation of novel genomic technologies in diverse hospital settings presents unique challenges.
Purpose of the Study:
- To characterize multidisciplinary team (MDT) views on implementing rWGS as a first-tier test for critically ill children.
- To identify key themes influencing the adoption and integration of rWGS in pediatric critical care.
Main Methods:
- Qualitative interviews were conducted with MDTs and hospital leaders across 5 tertiary children's hospitals.
- Interviews were informed by implementation science theory to explore the rWGS implementation project.
Main Results:
- Five key themes emerged: need for rWGS champions, educational requirements, decision-making processes, workflow adaptations, and overall perceptions.
- A composite clinical workflow diagram was developed, highlighting variations in implementation practices.
Conclusions:
- Findings offer insights for designing interventions to support the adoption, scale-up, and sustainability of rWGS.
- These insights are crucial for integrating rWGS and similar novel technologies in neonatal and pediatric critical care environments.
Objective:
To characterize the views of members of the multi-disciplinary team regarding the implementation of rapid whole-genome sequencing (rWGS) as a first-tier test for critically ill children in diverse children's hospital settings.
Study Design:
Qualitative interviews informed by implementation science theory were conducted with the multidisciplinary patient care teams and hospital leaders at each of the 5 tertiary care children's hospitals involved in a statewide rWGS implementation project.
Results:
Our analysis revealed 5 key themes regarding the implementation process across the sites: the need for rWGS champions, educational needs and strategies, negotiating decision-making roles and processes, workflows and workarounds, and perceptions about rWGS. From the findings a composite clinical workflow diagram was developed to summarize all of the processes involved in the implementation of the test, and the key areas where implementation practices differed.
Conclusions:
These findings provide insights for design of interventions to support adoption, scale-up, and sustainability of rWGS and other novel technologies in neonatal and pediatric critical care settings.
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