An ethnographic study of blood sampling practice
We will undertake in-depth studies across three NHS trusts to identify the organisational,social and behavioural influences that shape the reliability of blood sampling. Ethnographic observations will be conducted across emergency departments, admissions units, hospital wards and microbiology laboratories in the three participating trusts. While centred on the main ED in each trust, observations will not be limited to this setting.
Focus of observations:
The study will examine factors influencing practice along the pre‑analytic blood culture pathway, including:
- Which staff groups request and take blood samples
- How the blood culture pathway operates within each site
- Gaps between ordering and collection of blood culture samples, and the reasons for these
- Decision‑making around antibiotic prescribing and blood culture sampling
- Organisational pressures such as ED/admissions demand, shift patterns, and system‑level processes
How we are collecting data:
- Fieldnotes: extensive notes recorded in a diary‑style format
- Audio reflections: recorded summary reflections
- Local documents: collected and analysed where they are relevant to blood culture sampling
- Embedded interviews with key staff along the pathway: including junior doctors, other sampling staff, and microbiology personnel
Analysis: 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.
Key findings
Approximately 80 hours of observations across the three hospital sites have been completed and 37 interviews with staff in key roles along the pathway. Observations and interviews identifed four challenges to reliable blood culture sampling: