Table II.

Fitting in with clinical practice: illustrative quotations.

Theme 1: Fitting in with clinical practice
Category	Illustrative quotes
Navigating ED involves understanding: 1) the challenge of identifying all potential participants in the fast-paced ED; 2) the impact of patient pathways on recruitment; and 3) the impact of the environment on families.	1) The challenge of identifying all potential participants: They (clinical staff) can’t even think about doing research because their brain doesn’t have the capacity. Even though they’re trained it’s just not feasible and I suppose you’re always going to get that a bit. (RN20)
	2) The impact of patient pathways on recruitment: At the trauma meetings, we pick up any patients that have been admitted overnight to the hospital that are a potential (recruit) for the study. Otherwise, our patients are coming in via the emergency department and then they are potentially getting picked up at what we call a virtual fracture clinic. So, they may have a telephone call or attend an actual clinic where they are reviewed by an orthopaedic clinician. Obviously at that point it may be that they’re too far down the line to be eligible for the study. Or it may be that they’ve already had quite a lot of information to say that they may be getting a manipulation or they may just be staying in a cast, there’s a lack of equipoise at that point. (RN2)
	3) The impact of the environment on families: I think parents needed time and information. Sometimes in the rush of the emergency department, the noise in the background and the concern and the fear about their child, especially if their child is crying and in pain, sometimes bringing up the topic of participating in a study might sound a bit academic. It is not the time for it. (Clinician12)
Making sense of the study involves: 1) interpreting the study’s eligibility criteria; 2) understanding the impact of current patient pathways on eligibility; and 3) making sense of the treatments within the trial.	1) Interpreting the study’s eligibility criteria: I think we had an idea that we see a lot of distal radiuses (fractures) in kids, but we don’t actually operate on a lot here. So, I think we had in our heads that we had loads and loads but actually when it comes down to it, and to fit the criteria, they’re quite rare and we don’t get them very often. (RN1)
	2) Understanding the impact of current patient pathways on eligibility: Our emergency department are very good if it’s a fracture, which they can manipulate well and give pain relief. They can just do it there and then and send them on their way and they won’t think “Oh, this could actually go into the CRAFFT study”. (RN5)
	3) Making sense of the treatments within the trial: Initially there were a couple of areas we were not sure about, particularly about the inclusion criteria - for example, if a child was given morphine would that be considered sedation…or would that be considered a non-surgical option and just a simple analgesia. (Clinician12)