An ethnographic study of blood sampling practice
In-depth ethnographic studies, in three NHS trusts will be undertaken to identify the organisational, social and behavioural influences on reliability of blood sampling.
We will conduct ethnographic observations in the three participating trusts to understand the factors that impact on practices along the pre-analytic blood culture pathway in acute care. Observations will be centred on but not limited to the main ED in each trust. We will conduct around 150 hours of observations in total across the three sites in ED and admissions units, other hospital wards, and microbiology laboratories. Two periods of observation will be conducted in each site, each over several days. Initial observations will focus on documenting which staff members are responsible for requesting and taking blood samples, and researcher familiarisation with the blood culture sampling pathway within the site. During this initial phase we will also collect observational data on gaps between blood culture sample ordering and collection, and map the reasons for this. Subsequent observations will include in-depth observations of practice related to antibiotic prescribing and decision-making about blood culture sampling and blood culture sample collection. We will gain insight into organisational factors that impact on the pre-analytic pathway, for example, levels of demand on the emergency department / admissions unit and shift patterns, and the impact of organisational systems and activities.
Data will be recorded in the form of extensive fieldnotes by the researcher in a diary-like format, and audio-recorded data summaries. Local documents relevant to the blood culture sampling pathway will be collected and analysed. Within the ethnographic study we will conduct embedded interviews with key staff along the pathway. This will include junior doctors and other staff responsible for requesting and taking blood samples, as well as other key staff along the pathway including microbiology staff. We will explore individual perceptions and behaviours, norms, and social influences that shape individual behaviour and collective action. Data will be analysed using NVivo software with analysis drawing on the constant comparative approach. Our analysis will include using observational and interview data in the co-design workshops to inform the development of visual representations of the blood culture sampling pathways in each hospital.
Outputs:
Information on organisational, social, and behavioural influences on the pre-analytic blood culture pathway, to inform the co-design process; publication describing dynamics of collective action in the pre-analytic blood culture pathway.