Hans Rosenberg

Background Providing guideline-based care for patients with skin and soft tissue infections improves patient outcomes. The Canadian Emergency Department Best Practices Checklist for skin and soft tissue infections was recently developed for use by emergency physicians. Objectives To identify barriers and facilitators to using the skin and soft tissue infection checklist by emergency physicians. Methods An interview guide was developed based on the theoretical domains framework and piloted on two interview subjects. Following minimal refinements to the interview guide to decrease repetitiveness and improve clarity, from August to December 2024 we conducted semi-structured interviews with Canadian emergency physicians. The transcripts were anonymized and independently coded using direct content analysis, and specific beliefs were generated by grouping similar responses. A saliency analysis was conducted to identify relevant domains. Results Fifteen interviews were conducted involving emergency physicians across eight Canadian provinces. Six theoretical domains framework domains were identified as relevant: knowledge, beliefs about consequences, intentions, memory/attention/decision processes, environmental context/resources, and behavioral regulation. Competing demands (busy environment, many decision tools) were identified as potential barriers, whereas using technology (e.g., electronic health record integration) and the presence of learners were identified as facilitators to using the skin and soft tissue infection checklist. Conclusion This qualitative study using the theoretical domains framework identified barriers and facilitators to using the skin and soft tissue infection checklist by emergency physicians. Our findings form a basis for developing strategies to improve evidence-based care of skin and soft tissue infections in the emergency department.