Health Care Providers' Perspectives on Early Warning Systems for Acute Respiratory Infections in Canada: Qualitative...

Acute respiratory infections (ARIs) remain a significant global health challenge and are the second leading cause of disease burden and mortality. Early warning systems (EWS) play a key role in detecting clinical deterioration, alerting health care providers (HCPs), and supporting pandemic surveillance. While existing literature highlights HCPs' positive experiences with EWS in confirming clinical assessments and guiding escalation, perspectives on how these systems can be optimized for ARI management remain underexplored.

As Canada continues to develop and operationalize EWS for outbreak and pandemic preparedness, this study aims to explore the experiences and insights of primary care providers, emergency department (ED) physicians, and researchers regarding the use of EWS for ARI management in Canada.

Eleven participants, including primary care providers, ED physicians, and researchers from urban and rural settings across 5 Canadian provinces (Ontario, Newfoundland and Labrador, Quebec, British Columbia, and Manitoba), were recruited in 2024. All participants regularly managed patients with ARIs or played key roles in pandemic response. A codebook thematic analysis was conducted to identify patterns and themes, with subthemes organized under broader thematic categories. Data saturation was assessed during the analysis phase. The study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.

Among the 11 participants, there was approximately equal representation across gender and age groups, and more than 90% had over ten years of experience in ARI management. Three overarching themes emerged. First, participants demonstrated general awareness of the use of EWS in ARI management, including outbreak detection, screening and triage support, and informing clinical decision-making. Technologies and surveillance tools used during the COVID-19 pandemic were frequently referenced; however, understanding of specific EWS and their application to ARI management was often limited. Second, participants identified key attributes of an effective EWS as accuracy, timeliness, integration, and equity, emphasizing the need for seamless integration into existing Canadian health care workflows without increasing administrative burden. Third, anticipated challenges were described across 4 stages of EWS development, including initiation (funding and privacy concerns), implementation (outdated data systems and limited legislation), use (staff shortages and capacity constraints), and evaluation (lack of standardized and innovative evaluation approaches).

This study engaged 11 experienced HCPs and researchers who were directly involved in patient care and public health response to ARI outbreaks and qualitatively explored their perspectives on EWS for ARI management and pandemic preparedness. The findings identified 3 overarching themes regarding the general knowledge, desired attributes, and anticipated challenges of EWS in ARI management, highlighting the importance of co-designing EWS with clinicians, researchers, and other key stakeholders to improve their effectiveness and integration into clinical practice and pandemic preparedness across Canada.