This first theme focuses on how respondents first heard of the alert system and were instructed how to use it, and their initial reactions to becoming part of the system.
Getting to know the alert system
Some respondents had already used a similar system and so found the transition to using it for the research straightforward:
I’ve used QlikView already so I’m familiar with it . . . [researchers] took me through the system and I basically got on with it.
C6:1
. . . I’d used QlikView previously, some of the trust data’s on QlikView itself . . . I think [researcher] probably discussed it at one of our senior doctor meetings and then it was introduced, and we’d had a chat about using it . . . that the on-call consultant would use it every day to identify patients.
C4:1
I basically was using it in a previous job role . . . to access A&E [accident and emergency] data so we was [verbatim] kind of familiar with it from there. And then . . . I’ve just adapted the bits of it that I’m using really.
ON2:1
The nature of the first introduction appeared to be informal and brief; some participants had difficulty remembering it:
I think it was at a meeting that [researcher] briefly mentioned but it wasn’t a formal you know, unveiling of the system . . .
C1:2
I don’t think there was any formal training that I remember, just opened it and started using it.
C3:1
I can’t remember actually . . . I suppose [researchers] must have shown us, shown me how to use it but I honestly can’t remember.
C2:1
The outreach nurses appeared to have had more formal training, which they rated highly in terms of meeting their needs, and they particularly valued the accessibility of the researcher:
. . . when [researcher] trained us, I certainly felt that it was very adequate. We had several sessions with him. And I feel very much that if I needed anything I could always get what I wanted from [researcher] so it wasn’t . . . it wasn’t just an informal thing for us.
ON1:4
I mean [researcher] is very adaptable and approachable in terms of giving us what we need, I think, as a whole team across the sites in terms of education and updates and stuff.
Some of the consultants had been involved in the project’s conception so they were already knowledgeable about it, as explained here:
I was aware of its development and you know [researcher] would talk about it whilst it was being developed and ask for ideas and suchlike . . .
C5:2
Most respondents felt that the system was relatively straightforward and that they were able to learn experientially, without the need for more formal training:
. . . a lot of it was sort of learning as you tried to use the system, you try . . . and you learned how to access this bit of it or that bit of it . . .
C1:1
. . . it’s not very complicated, but yes we were given passwords for access to QlikView and the AKI system and then I think [researcher] took a quick whizz through and that was it.
C5:1
. . . you learn the tricks as you go, so I think expectations of how you’re taught how a system works are probably too high . . . the practicalities of doing it– actually that experience is quite a useful tool.
C4:3
First reactions to the system
All respondents appeared to be keen to support colleagues and welcomed the alert system. There was also an acknowledgement of its importance and potential contribution to innovation and change in renal medicine:
. . . well I thought it was a good idea because we I mean we have been doing this with chronic kidney disease and advising GP [general practitioner] practices so I thought with acute kidney injury . . . it was quite a good idea and I was keen to continue with it and help out the research process.
C1:1
I think it’s great that there’s a system in place to pick people up.
ON4:26
It’s important work, not only for the trust but it fits with the recommendations of the NCEPOD report for AKI . . . and the general Department of Health Research and Innovation Agenda . . . yeah, so good for patients and practice.
C6:1
In addition to recognising how the system could improve patient care and impact on practice, other respondents discussed the proactive nature of the alert system in bringing this about:
. . . people can be going‘off’ without anybody realising, so having an alert system that actually picked it up and prompted the doctors looking after them to actually have a think about what might be going on with this patient seemed like a very good idea.
C5:1
. . . it’s our only means of identifying some of the sick patients . . . and quite often some of these groups of patients we will only pick up on because they’ve been identified through the alert system . . . Had we not had that access to that we probably would never even know they’re in hospital.
. . . well I think it’s a very good idea . . . I think is very important and using the benefits of the expertise that we have in the trust for building these platforms I think makes a lot of sense, I’m enthusiastic.
C2:1
One respondent, however, did feel a sense of imposition, suggesting that there was little choice in terms of participation:
. . . we were told that we had to start using it, we were told that it was part of a research and that they were trying to sort of incorporate it into our normal daily activities and practice.
C1:1
The outreach nurses also had some collective reservations about the added workload and goodness of fit with their role, an aspect elaborated on later:
I’m not sure we were totally warm to it because it was just something else to add to our job . . . And we’ve got one of those umbrella jobs where we . . . ‘Outreach will do it anyway’ . . . And then it was like oh. But . . . it is quite appropriate to see the patients very often because they’re sick and they have renal failure . . . But we weren’t exactly, ‘Yay!’
ON1:4/5
I . . . I sort of personally queried why this wasn’t being taken up by the renal satellite unit . . . and I did feel a little bit well I’m not quite sure that that’s appropriate for us.
ON3:5
Summary
Initial responses to the alert system appeared to be encouraging. There was strength of opinion regarding the desire to support colleagues and the research endeavour, and an understanding of its potential contribution to renal medicine. Given that the alert system has been in operation for nearly 2 years, the sentiments expressed by most respondents appeared to be enduring, evidenced by their use of the present tense when describing their views. Alongside this, however, there was a tendency for the outreach nurses to greet the system with a degree of uncertainty regarding their roles. Outreach nurses had more formal training, which they appreciated, and, although seemingly brief and informal for the consultants, the induction process appeared to be sufficient for engaging colleagues given that the technology was not complex.