Table 10.

Site E summary

Evidence*	Teamwork	Communication	Leadership
-Had not used an algorithm to date	-Not very organized and low cooperation overall	-Low level of intra-ACC staff communication	-Staff feel unevenly supported by leadership
-Very interested in getting some guidance	-Internal divisions where some team members cooperate, but not others	-Used all means available to talk (email, phone, IM, face to face)	-Staff felt poorly informed about ACCII
-Receptive to algorithm	-ACC staff note that they do not have great teamwork	-ACC staff note that communication among ACC team is strained	-Sense from staff that leadership is not very interested in ACCII
-Concerned about workload implications of the 7 day return for out of range patients recommended by the algorithm		-Communication between ACC team and leadership was rare—ACC team had heard very little about the ACCII	-Leadership supported sending staff to ACCII meetings

*Most influential contextual factor.