Illustrative quotes related to variation across region and institution in clinical decision-making processes
| Subthemes | Participant quote |
| Current CDS tool versus guideline/criteria use | ‘We’re a district hospital that—we don’t have a pediatric ICU. We do not even have an ICU per se, but we manage our patients in general wards. We actually do not have specific guidelines or protocols for pediatric sepsis…Most of the decisions are subjective. Our clinicians or our physicians make subjective decisions. In our wards, we typically base our decisions on children presenting with fever. Sometimes our diagnosis is confirmed at discharge. If you go through our records, we discovered that most of our sepsis diagnoses are confirmed at discharge based on the clinician’s treatment that has been followed throughout the time of admission…that is how we approach our patients, but we are working on developing some protocols to be used.’(Clinician, Africa) |
| Challenges in paediatric sepsis diagnosis related to infectious aetiologies | ‘Many of the tropical diseases that many of our colleagues have highlighted, malaria, dengue, maybe scrub typhus and all, which often do not find a mention in the sepsis guidelines which come from the developed world because they don't see this particular spectrum. I think we would need to focus on that as well in terms of the non-bacterial illnesses and all where the supportive care is important, but antibiotics may not be all that important.’(Clinician, Asia) |
| Prevalence of offline, often paper-based formats, for guidelines, criteria and tools | ‘The big advantage, in our context, is the availability of paperwork makes it easier for people in areas where there’s not technology. Also, because in order for us to open an app [digital application), some of the apps require us to have internet, and internet’s very expensive in these parts of the world…It’s cost-prohibitive to you to use. If you are to make it usable is to have it written in a way that is open offline. Having an offline version means the same thing–that we’re just writing on paper–but it’s digital. Whereas having it in a way that’s already online, if you have update, then it comes automatically.’(Administrator, Africa) |
| Limitations in paediatric sepsis recognition and treatment | ‘One of the things I find difficult is the variability in the age of children. In children, we have—we assist from neonates to adolescents. Variability in vital signs makes it difficult for the system to recognize them. The other thing is that we can’t just base only on vital signs, but there are other things in the child’s general appearance that the system can’t see. For example, alterations in the child’s perfusion…The general appearance of the child is a very important thing and we can’t leave it all to the system. Then, I think that what makes it possible for us to capture these patients well is the mix between a system and software that enable us to somewhat stabilize the decision making a little; but also the staff training to be able to recognize those children who don’t look good.’(Clinician, Latin America) |
CDS, clinical decision support.