Table 2.
Acceptance of and experiences with RDT-based screening - illuminating quotes.
| Installation |
|---|
| Selecting staff and negotiating workload |
| “So, there were no staff resources to implement these RDTs between today and tomorrow. Per decree it was said this is being done from tomorrow onwards, and that makes sense, that's ok, but how you please implement it, for that we were on our own. And there then people just said, ok we do this on top. I assume that people started going to work earlier, or certain tasks were being left undone. It somehow worked.” (Department head) |
| “When implementing something new like that, one key question is: What staff? So, when building such a new team you always need a core team in the beginning which you have built consciously. These have to be people with regards to personality, experience, visionary thinking, well organized, to be able to work with each other … because they have to work closely together, shape this, fill this idea with life. … It's about liking to do something like that!” (Department head) |
| “Of course, some (departments asked to provide staff for screening) sometimes were like ‘Oh, but it's difficult.’ But when you then talk about it and constructively discuss about, ok, how could you partly compensate for the departure of this employee, or what other possibilities are there, some others who don't want to work in the screening center … a lot of that works through larger circular exchange. But we really take that serious, the nursing department has to be ready to go along, otherwise it makes no sense.” (Department head) |
| Initial Implementation |
| Bolsters a sense of safety and security |
| “It's very effective. … For us it gives security, for the staff it gives security, and for the employees, and for the general situation when patients come to the ER and space is limited then you know whether someone there has a COVID infection or not. So it gives you incredible security.” (Provider performing RDTs) |
| “Sometimes it also gave this false sense of security, ahem, that you just didn't isolate patients because you trusted the test a lot. But I think if you … yourself follow your own gut feeling and … watch out, then it works. Rather with RDT than without RDT I think.” (Provider performing RDTs) |
| “That also gives (the patients) a sense of security. Most patients are in a two bed room here, with another unknown person. That's one thing. And it also conveys the security that this institution knows what they are doing, ahem, also how the ways here are, that starts at the entrance, how that is factually separated.” (Department head) |
| Full Implementation |
| Impact of within-hospital dynamics |
| “Many say that they think it's great how it works, the procedures are good. But there are some risks that … especially in the last time increase. Because in a way, it's a form of leverage. So there are departments where a patient comes who has certain laboratory values, some inflammation indicators, that don't tell you anything regarding COVID. But they then start, because they are afraid themselves, to send them to us, although there is in fact no reason. And are saying that they only allow the patient into a room, for a talk, if we test him before. That's difficult … because in fact there is no reason, but of course you can understand on the human level that if someone is sitting there who is coughing and whatever, I as well would like to have a swab.” (Provider performing RDTs) |
| “(The main challenge is) to stay firm. To not let anyone twist you around the little finger. ‘could you quickly … or I want because I have a Prof. Dr. in front of my name.’ To just endure certain things, those maybe are the barriers.” (Provider performing RDTs) |
| Desire for clear and collaborative communication |
| “So, if you ask me what could be done differently, sometimes one could get the clinicians into the room, I think, when you would include a representative from surgery, from dentistry, from internal medicine, from everyone. And then together for the implementation of such a test say: Ok, that's our plan, does something speak against that, based on your professional experience? That didn't happen, and the time for that would have been there. And I think that then, ahem, the one or the other thing could have been done earlier and maybe better. And when you get the people on board, then the compliance is higher, the acceptance is higher. And with the higher acceptance the result is better” (Department head) |
| “I also have to say that (the screening regulations) are changed all the time. It's not all that easy to maintain an overview regarding who is screened where.… Such things I'm usually only told by the nurses.” (Provider performing RDTs) |
| “That would be one thing, to write that you have to come 1 h earlier than your appointment. … Maybe that would have been one thing to write or say in advance. …. Now I have to tell them upstairs that I had to wait this long. Of course they know that, but that could have been avoided. … They told me that I would have to get tested but not how long this would take.” (Male patient, undisclosed age) |
| Weighing of RDTs versus other testing approaches |
| “Everyone knows we don't have anything better. … And everyone knows that we have a quota (of identifying positive cases) of 90%, and that's true. And the small risk that is left … that has to be tolerated. But it's better than having nothing, that is a fact, and everyone can live with that and has accommodated to that, and I don't think anyone would want it otherwise.” (Department head) |
| “Regarding the RDTs, how much I trust them … rather limited in fact. Rather limited. Ahem, I often had it now that the RDT then surprisingly was positive, and we then were able to isolate early on. That was great. But I also already had it that, on the other hand, that the RDTs were false negative. And, ahem, therefore (my perception of the RDTs) is rather ambivalent.” (Provider performing RDTs) |
| “What confuses me, this no PCR test. That I'm curious about. (My son-in-law) also had a surgery in Hamburg, and he had to come in the morning and had to sit the entire day in a quarantine room, and they did a PCR test. And here, considering it's Heidelberg University Hospital, I'm surprised. Very surprised. Extremely surprised.” (Male patient, 73 years) |