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Table 3 Description of themes used for focus groups coding

From: Factors influencing the implementation and uptake of a discharge care bundle for patients with acute exacerbation of chronic obstructive pulmonary disease: a qualitative focus group study

Theme Description
1. Process of care Definition: “What is actually done in giving and receiving care. It includes the patient’s activities in seeking care and carrying it out as well as the practitioner’s activities in making a diagnosis and recommending or implementing treatment” [30]
 1.1. Influencing patients Example: cost of medications and access to services from the patient perspective
 1.2. Influencing providers Example: not sure who is doing what, challenges with patient diagnosis, patient transfer to another unit
 1.3. Influencing care system Example: lack or presence of pulmonary rehabilitation services, access to pharmacist, lack or presence of family doctor
2. Human capacity in care setting Definition: the ability of the people implementing the discharge care bundle items (nurses, RRTs) to make sure the items are attended to
 2.1. Time constraints Example: not enough nursing/RRT staff time to implement additional steps in care, patients do not spend enough time in ED
 2.2. Volume and staffing issues Example: nursing/RRT staff shortage
 2.3. Education and training of health care providers Example: training of staff on inhaler techniques, training of staff on discharge care bundle
3. Communication and engagement Definition: the level of engagement and communication within single setting (such as buy-in) or across specializations (such as acute primary care)
 3.1. Patients’ engagement Example: communication between patient and provider, patient engagement/interest in self-managing, information overload
 3.2 Providers’ engagement Example: buy-in from frontline/physicians
 3.3. System’s engagement Example: communication and collaboration across sites, multidisciplinary communication and collaboration
4. Attitude and perception of change Definition: set of psychological/administrative responses to planned change. This includes positive and negative responses
 4.1. Patient attitudes Example: do not want to do new things/willingness to do so, opinion that the intervention is not worth the effort
 4.2. Provider attitudes Example: opinion that intervention not useful, attitude towards checklist—positive and negative
 4.3. System attitudes Example: administrative obstacles, support from executive management
  1. ED emergency department, RRT registered respiratory therapist