ArticleImplementation science communications2025
Describing the determinants of fluid prescribing and fluid balance optimization in the pediatric intensive care unit: a qualitative study at a community hospital.
Article in Implementation science communications, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundCritically ill children tend to receive fluid volumes exceeding physiologic requirements despite evidence demonstrating harm with increasing net positive fluid balance. However, interventions aimed at optimizing fluid balance have yet to demonstrate significant clinical benefit, likely because there are multiple drivers of this complex problem. In this study, we used qualitative inquiry to describe the current practice at a community pediatric intensive care unit and discover potential barriers and facilitators to clinical practice change.
methodsWe designed a semi-structured interview guide informed by the consolidated framework in implementation research (CFIR) and conducted interviews with attending physicians, dietitians, nurses, nurse practitioners, pharmacists, and physician assistants. We coded interview transcripts according to a deductive coding framework based on the CFIR with additional inductive codes as pertinent to the clinical problems described. Referencing Braun and Clarke's six steps to thematic analysis, we analyzed the coded data and developed themes to synthesize findings and draw meaningful insights for clinical practice.
resultsWe interviewed 20 participants who practiced in 5 distinct healthcare roles. Clinical priorities and suggestions for improvement differed among healthcare roles, but four key themes guiding fluid optimization emerged: "Positive Self-Perceptions of Fluid Optimization," "Delegation and Autonomy in Fluid Prescribing," "The Influence of EHR Design on Clinical Practice," and "Clinical Uncertainty and Predictive Support." We mapped each of the themes with key CFIR domains and constructs as well as potential barriers and facilitators to development and implementation of a clinical innovation to fluid optimization.
conclusionsInterview participants recognized the problem of fluid overload but offered mixed perspectives on how to change clinical practice. Recognizing the multidisciplinary nature of caring for critically ill children with potential variations in viewpoints, we used the CFIR as a solution rooted in complexity to improve understanding of the problem, identify existing barriers, and leverage facilitators before designing a contextualized and practical strategy to optimize fluid balance.
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