Evaluation of the implementation of the Critical Care Asia and Africa Intensive Care Unit registry in Ethiopia

Table 1 Feasibility, acceptability and perceived sustainability of the Critical Care Asia and Africa Intensive Care Unit registry in Ethiopia

Topic	Theme	Subtheme
Feasibility	Data collection	Online ICU registry platform
		Data collectors
		Integration into clinical activities
	Data quality	Accuracy and completeness
		Missed data
		Monitoring
	Needs for success	Resources
		Training
		Communication
Acceptability	Utility	Research
		Quality improvement
		Clinical care
		Current use
	Accessibility	Ease
		Who has access
	Comparison to other methods	Organization
		Comprehensiveness
		Availability
Perceived sustainability	Institutional future	Expectations
		Threats
		Adaptations
	Ownership	Distrust
		Data loss
	Expansion	Stakeholders
		Challenges
		Solutions

ICU: Intensive care unit.

Table 2 Facilitators and barriers to implementation of the Critical Care Asia and Africa Intensive Care Unit registry in Ethiopia

Characteristics	Explanation
The innovation
Relative advantage	Data stored online is safe and easily accessible
Compatibility	Easy to collect data using online platform with tablets
Observability	Pilot implementation at SPHMMC and AaBET and successes in Asia can demonstrate utility to other hospitals in Ethiopia
Adaptability	Would be helpful to have a means of offline data collection and asynchronous upload
	Desire for alterations in dataset to suit lower resource or specialized hospital
Communication and influence
Champions	Site leads who can advocate to hospital leadership
	Need to prioritize generating awareness and buy-in from hospital leadership and quality office
Social networks	Lack of awareness and support from ICU clinical staff
Outer context
Incentives and mandates	Will be helpful to get buy-in from the Ministry of Health to support broader implementation and sustained use
Interorganizational norm-setting and networks	Potential to develop a regional ICU registry network for research and QI
System readiness for innovation
Tension for change	High perceived value of the collected data among ICU registry team
Assessment of implications	Need to ensure that ICU clinical staff are aware of the utility and accessibility of the ICU registry data
Dedicated resources	Designated data collectors without concurrent clinical responsibilities, not all hospitals can afford to take staff out of clinical roles for data collection
	Continuous electricity and internet access, not universally available
	Equipment and financial support from CCAA
Adopter
Needs/motivation	Can fulfill hospital reporting mandates
	Desire to conduct research and quality improvement projects
	Skepticism about if or how data are being used
	Distrust about who has ownership of collected data
Skills	Staff with specialized knowledge needed for data collection and supervision, not available at all hospitals
Implementation process
Human resources	Importance of initial orientation and ongoing training for site leads and data collectors
	High workload for data collectors
	Current staffing model leads to gaps at night and on weekends
	High turnover of ICU staff and inexperience providers could be a challenge in some hospitals
Hands-on approach by leaders	Engaged site leads needed to monitor quality of collected data
External collaboration	Training and technical support from CCAA team

SPHMMC: St Paul’s Hospital Millennium Medical College; AaBET: Addis Ababa burn, Emergency and Trauma Hospital; ICU: Intensive care unit; CCAA: Critical Care Asia and Africa.