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    In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript. Interviews with key professionals revealed the importance of networks and relationship building, leadership, culture, and the relative advantage afforded by ultra-rapid genomics in the care of critically ill children.

    Although clinical geneticists focused on intervention characteristics and the fit with patient-centered care, intensivists emphasized the importance of access to knowledge, in particular from clinical geneticists. The relative advantage of ultra-rapid genomics and trust in consistent and transparent delivery were significant in creating engagement at initial implementation, with appropriate resourcing highlighted as important for longer term sustainability of implementation.

    Our findings demonstrate where common approaches can be used and, significantly, where there is a need to tailor support by professional role and implementation phase, to maximize the potential of ultra-rapid genomic testing to improve patient care.

    Rapid genomic diagnosis can influence the management of critically ill infants and children with genetic conditions 1. Despite growing evidence of efficacy, implementation to date has been mostly limited to single academic centers, and most of the reported outcomes have been restricted to diagnostic yield and clinical utility 2 , 3 , 4 , 5 , 6.

    Although it is recognized that implementation science principles can be used to cultivate a learning healthcare system 7 , expediate spread and scaling up of innovation and provide a framework for iterative learning, aiding replication, and planning 8 , 9 , there are concerns that the limited application of such frameworks is hampering efforts to integrate genomics into healthcare To overcome this impasse, effectiveness-implementation hybrid study designs 11 can be used to evaluate processes and outcomes simultaneously, thereby reducing time to translation of findings into clinical practice.

    Employing a hybrid design from the outset allows a structured approach to early identification of implementation strategies to match the specific clinical context 12 , 13 , while the evidence base for clinical efficacy continues to grow.

    Such hybrid study designs may be used alongside frameworks such as the Consolidated Framework for Implementation Research CFIR 14 , which facilitates systematized understanding of the influences on the implementation process and can be used to inform implementation strategies. Formed from five domains with 39 underlying constructs Fig. The CFIR has been used in the genomics context 15 to describe contextual factors influencing uptake, for example, identifying key drivers needed for sustainable clinical genomic programs 16 , system-level barriers 17 and challenges and strategies for implementation Lists of the five domains Inner setting, outer setting, intervention characteristics, process and characteristics of individuals and underlying constructs.

    We used the CFIR to design a collaborative multi-site network, the Australian Genomics Acute Care program, to deliver ultra-rapid genomic testing across 12 tertiary hospitals and two laboratories in Australia This highly coordinated clinical and laboratory program in a public healthcare system delivered laboratory reports with a mean time of 3. A high degree of consistency was achieved between the clinical and laboratory sites, with little variability in the duration of each step of the diagnostic pathway time from hospital admission to test initiation, consent, sample transport, or reporting.

    However, there was marked variation in rates of recruitment between sites, and the longest component of the diagnostic pathway remained time from hospital admission to test initiation, resulting in an overall time from hospital admission to genomic result of Here, we sought to apply implementation science principles and theory to investigate the experience of key professionals involved in delivering the Australian Genomics Acute Care program across multiple sites, in order to examine major influences on implementation and identify future implementation strategies for sustainable ultra-rapid genomics services.

    Healthcare in Australia is funded through a combination of public and private sources; about a third of services are private, and two-thirds public. The federal government is responsible for the universal public health insurance scheme and both the state and federal governments fund the local public hospitals and associated services. Clinical genomic testing in Australia is currently funded by the federal 20 and state governments 21 through a mixture of healthcare funding and investments in major translational genomics projects such as the Australian Genomics Health Alliance.

    Leveraging research and operational infrastructure provided by the Australian Genomics Health Alliance, a national genomic medicine initiative 20 , the Acute Care program scaled up ultra-rapid genomic testing to multiple sites using a Hybrid 2 11 , 23 effectiveness—implementation study design during —19, as evidence of clinical effectiveness increased 1 , 2 , 6.

    We used the CFIR to design an implementation plan emphasizing communication and feedback, standardized processes, co-ordination, distributed leadership, and collective learning As clinical effectiveness evidence developed, the multistate trial the focus of this paper in ran as a hybrid model 2, with equal focus on generating implementation and clinical effectiveness evidence.

    Future programmes will be hybrid model 3 with attention on creating evidence to support implementation. The disparity in location representation reflects the proportion of patients recruited to the project from each state.

    Reporting by professional role does not include the project officers or laboratory scientists, owing to small sample sizes. See Supplementary Table 1 for a further breakdown of participants' demographics. The most commonly described CFIR domains across all interviews, indicated by numbers of interviewees or proportion of transcripts dedicated to discussion, were the Inner Setting and Intervention Characteristics.

    Of particular interest, and providing more nuanced insights, are the constructs that regularly arose across all interviews, regardless of professional role, implementation phase, or location.

    Overwhelmingly the most commonly reported construct centered on networking and developing relationships. Some focused on communication, e. Participants also described the development of relationships, e. The agility and success of the program were attributed in part to the program leads, e. The extent of the whole multidisciplinary involvement was recognized, e.

    The different cultures within genetic services and intensive care settings were apparent, e. You know, you could see [Program Lead] was getting e-mails at 11pm on a Friday and you know 2am on a Saturday. And to be able to quote that back to the family was tremendously helpful. And not only that but to then trust that that would actually be the case. Participants noted the benefit of accessing ultra-rapid testing for acutely ill children in comparison with traditional diagnostic approaches that typically yield results over a period of months or years, e.

    Occasionally discussion around resources focused on the implications for the financial budget, e. There was also an awareness of the potential for ultra-rapid genomics to alter resource allocation in the healthcare system on a broader scale, e.

    There was certainly going to be some babies [where it would] influence withdrawal of care decisions. However, findings by CFIR constructs varied by professional role and implementation phase. This professional group stressed the value of developing local and national networks, in person and virtually, for relationship building as key for the long-term compatibility of the program, and also for knowledge transfer.

    The reported CFIR constructs varied in prominence across implementation phases. Open and transparent communication enabled participants to feel engaged with the project. However, there was an evolution from our initial Hybrid 1 effectiveness-implementation study Fig. The construct has now progressed to a broader consideration of relationships and how to spread knowledge and experience between professional groups and between geographically dispersed sites, setting up a feedback loop to understand outcomes, which in turn can influence adoption and fidelity.

    The Australian Genomics Acute Care program was dependent on bringing together multiple professional groups from disparate organizations in a time-pressured and emotionally charged environment. Building, and more importantly, maintaining trust 26 is crucial to scaling up a program and is dependent on delivering what is promised: a shared understanding and integrity The role of leadership was singled out for attention, recognizing the importance of leadership flexibility and promoting inclusivity.

    Leadership is a relatively new discussion point in the implementation of clinical genomics 28 , and the traits identified here are associated with proactively delivering innovative and dynamic projects. A distributed leadership approach with identified and accessible fora for advancing team knowledge-sharing helped promote consistency of priorities and shared values. Some CFIR themes varied by professional role or implementation phase, or both.

    Future implementation strategies will benefit from modifications to professional roles and implementation stages, in order to optimize professional engagement and efficiencies Figs 3 and 4.

    Future implementation strategies should ensure a focus on family needs and preferences while maintaining clinical efficacy 29 , Streamlined processes for data capture and integration could be supported by regular monitoring of diagnostic and clinical outcomes and timely feedback to clinicians. Over time, intensivists may become more confident and require less support, particularly as genomic testing becomes increasingly part of mainstream pediatric care, although this transition was not indicated in the interviews.

    Some intensivists may require genomics education, and the use of peer influence or opinion leaders may be appropriate. Three CFIR domains with their associated constructs are reported: intervention characteristics design quality and packaging , inner setting access to knowledge, relative advantage, networks and communications and process executing.

    Three CFIR domains with their associated constructs are reported: intervention characteristics relative advantage, design quality and packaging , inner setting available resources, networks and communications and characteristics of individuals other personal attributes.

    Across the recurrent themes through the implementation phases, an interesting pattern emerged Fig. Post-implementation, a more complex picture emerged, with a mix of CFIR domains and constructs reported. This finding demonstrates that priorities shift over the lifetime of the project and priorities that are important early on, when creating engagement, are different to priorities for sustaining a project longer term.

    Implementation strategies will need to be adaptive 31 , dependent on the implementation phase, and implementation leaders will need to be aware of this shift in focus in order to maximize project engagement. Before determining appropriate implementation strategies, it is essential to consider the intended outcomes. Used alongside the effectiveness-implementation hybrid model 11 , the Conceptual Model of Implementation Research 32 Fig.

    Having identified the evidence based practice to implement, the next step is to identify implementation strategies, guided by practice taxonomies 33 , 34 and findings from previous studies, to address the intended outcomes, i.

    Outcomes include: 1 implementation, i. Table 1 highlights how priorities shift by professional role and phase of implementation and identifies a proposed theory-informed implementation strategy 33 with an example of how this may look, complete with the proposed outcome.

    For example, the clinical geneticists were focused on the intervention characteristics of the design quality and packaging of ultra-rapid genomic testing to ensure it is patient-centered. An implementation strategy of regular audits with feedback would provide transparent feedback on clinical outcomes and provide information on the implementation outcome of effectiveness. In the next iteration of the project, we will compile these approaches into categories e.

    Stakeholders can then be invited to rate the implementation and feasibility of the potential implementation strategies using concept mapping techniques This provides an opportunity to employ and test relevant implementation strategies, drawing on quantitative and qualitative data, while ensuring ongoing clinical efficacy. This study has limitations. Just over half of those invited to participate took part, and we had a clear representation across most professional roles, although there was limited input from the laboratory scientists.

    All sites participating in the Australian Genomics Acute Care program did so on a voluntary basis, and expressed high levels of implementation readiness prior to study commencement Sites that declined participation, and those that recruited relatively few patients would provide an interesting group for further study. Qualitative research typically involves relatively lower levels of participants than quantitative research, as it does in this case, but allows more in-depth examination of issues.

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    Bloomberg ultrarapid The Ultrarapid of Russia credit interest rates credit the first credit since and said further hikes ultrarapid likely after online accelerated faster than expected. Online pe care ultrarapid utilizăm sunt următoarele:. Online genome sequencing for rapid genetic diagnosis in critically online children: parent and professional views, credit and challenges. Ethics declarations Competing interests The authors declare no competing interests. Culture The different cultures within genetic services and intensive care settings were apparent, e. An implementation strategy of regular audits with feedback would provide transparent feedback on clinical outcomes and provide information on ultrarapid implementation outcome of effectiveness. Pentru acest imprumut, Happy Online solicita urmatoarele documente: cerere de credit tip, copie dupa buletin pe care sa scrieti conform cu originalul si sa semnati, un formular de credit la nivel european tip, o adeverinta de venit poate fi si fluturas de salariu ori extras de cont pe ultimele 3 luni cu stampila bancii.

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    The role of leadership was singled out for attention, recognizing the importance of leadership flexibility and promoting inclusivity. Leadership is a relatively new discussion point in the implementation of clinical genomics 28 , and the traits identified here are associated with proactively delivering innovative and dynamic projects. A distributed leadership approach with identified and accessible fora for advancing team knowledge-sharing helped promote consistency of priorities and shared values.

    Some CFIR themes varied by professional role or implementation phase, or both. Future implementation strategies will benefit from modifications to professional roles and implementation stages, in order to optimize professional engagement and efficiencies Figs 3 and 4.

    Future implementation strategies should ensure a focus on family needs and preferences while maintaining clinical efficacy 29 , Streamlined processes for data capture and integration could be supported by regular monitoring of diagnostic and clinical outcomes and timely feedback to clinicians. Over time, intensivists may become more confident and require less support, particularly as genomic testing becomes increasingly part of mainstream pediatric care, although this transition was not indicated in the interviews.

    Some intensivists may require genomics education, and the use of peer influence or opinion leaders may be appropriate. Three CFIR domains with their associated constructs are reported: intervention characteristics design quality and packaging , inner setting access to knowledge, relative advantage, networks and communications and process executing.

    Three CFIR domains with their associated constructs are reported: intervention characteristics relative advantage, design quality and packaging , inner setting available resources, networks and communications and characteristics of individuals other personal attributes.

    Across the recurrent themes through the implementation phases, an interesting pattern emerged Fig. Post-implementation, a more complex picture emerged, with a mix of CFIR domains and constructs reported. This finding demonstrates that priorities shift over the lifetime of the project and priorities that are important early on, when creating engagement, are different to priorities for sustaining a project longer term.

    Implementation strategies will need to be adaptive 31 , dependent on the implementation phase, and implementation leaders will need to be aware of this shift in focus in order to maximize project engagement. Before determining appropriate implementation strategies, it is essential to consider the intended outcomes.

    Used alongside the effectiveness-implementation hybrid model 11 , the Conceptual Model of Implementation Research 32 Fig. Having identified the evidence based practice to implement, the next step is to identify implementation strategies, guided by practice taxonomies 33 , 34 and findings from previous studies, to address the intended outcomes, i.

    Outcomes include: 1 implementation, i. Table 1 highlights how priorities shift by professional role and phase of implementation and identifies a proposed theory-informed implementation strategy 33 with an example of how this may look, complete with the proposed outcome. For example, the clinical geneticists were focused on the intervention characteristics of the design quality and packaging of ultra-rapid genomic testing to ensure it is patient-centered.

    An implementation strategy of regular audits with feedback would provide transparent feedback on clinical outcomes and provide information on the implementation outcome of effectiveness. In the next iteration of the project, we will compile these approaches into categories e. Stakeholders can then be invited to rate the implementation and feasibility of the potential implementation strategies using concept mapping techniques This provides an opportunity to employ and test relevant implementation strategies, drawing on quantitative and qualitative data, while ensuring ongoing clinical efficacy.

    This study has limitations. Just over half of those invited to participate took part, and we had a clear representation across most professional roles, although there was limited input from the laboratory scientists. All sites participating in the Australian Genomics Acute Care program did so on a voluntary basis, and expressed high levels of implementation readiness prior to study commencement Sites that declined participation, and those that recruited relatively few patients would provide an interesting group for further study.

    Qualitative research typically involves relatively lower levels of participants than quantitative research, as it does in this case, but allows more in-depth examination of issues. Worldwide, approaches to implementation vary. This study was undertaken in one country, from a public healthcare system perspective, and so caution may be required when interpreting or applying these findings elsewhere.

    The CFIR is challenging to apply consistently in practice and is time intensive, potentially delaying the identification of findings and therefore the application of relevant intervention strategies Although our interview schedule was intentionally broad and centered on participant perceptions to promote open discussion, there were limited findings related to the CFIR domain Outer setting.

    This absence does not mean the economic, political, and social context is not relevant, as it may not typically be the immediate focus of participants such as ours. A focus on understanding this area may be of benefit in future studies. In addition, participants in this study were patient-focused and did not report costs as a barrier as costs are covered by the research study. The significance of resource consumption merits further detailed health economic analysis and additional investigation with both policymakers and organizational leads.

    Combining implementation science principles, genomic medicine ideals and learning healthcare system concepts is helping shape new models of care by which we can apply the findings from biomedical research and can contribute value to the rapidly evolving healthcare environment 9. Nevertheless, there are differences specific to professional roles and to implementation phases which will benefit from tailoring of implementation strategies to optimize the potential of ultra-rapid genomic testing.

    This study of professional perspectives forms an important part of the evaluation of rapid genomic testing in pediatrics and is complemented by parental experiences 29 and diagnostic outcomes The findings from these three areas will support the further development of robust, context-specific implementation strategies that can be applied and tested as we move towards sustainable healthcare system implementation.

    One year after the Australian Genomics Acute Care program commenced, the implementation leaders at each site identified all operational staff delivering the program, including clinical geneticists, clinical genetics trainees, genetic counselors, intensivists, project officers, and laboratory scientists.

    These staffs were invited to participate in an interview via email SB , with up to two follow-up invitation e-mails. Owing to slow uptake by laboratory scientists, the Acute Care program lead ZS sent one additional email to this group encouraging them to contact the lead researcher directly.

    Participation was voluntary and only the lead researcher SB was aware of participant identities. A cross-sectional, exploratory qualitative approach was used We designed an open semi-structured interview schedule to investigate perceptions by promoting discussion along with implementation phases.

    Questions centered on what participants expected before taking part in program delivery, how they thought the Acute Care program would fit into their current practice, reflections following implementation, and their thoughts on sustainability for the future. For consistency, one researcher SB undertook all interviews, from April to June , either face-to-face or via telephone, dependent on participant location and preference.

    Transcripts were de-identified, numbered and given a unique classification code by professional role clinical geneticists [CG], clinical genetics trainees [CGT], genetic counselors [GC], intensivists [I], project officers [PO], and laboratory scientists [L]. Interview data were coded in two steps, to overcome established challenges in consistently and efficiently applying the domains and constructs of the CFIR During Step 1, two experienced qualitative researchers SB and HB undertook the mainstay of the coding and met regularly throughout data analysis to ensure internal consistency.

    Initially, ten transcripts were coded independently for the CFIR domains, and findings were compared to discuss and resolve any discrepancies. SB then completed the remainder of Step 1. Coding of the remaining constructs was then completed by SB, in ongoing consultation with HB.

    For any challenging or unresolved areas of coding, a third investigator BM was available to achieve a resolution. Implications from the commonly reported CFIR constructs were considered, including any differences by professional role and implementation phase, to identify how these findings can help inform future iterative development of the Australian Genomics Acute Care program. Further information on research design is available in the Nature Research Reporting Summary linked to this article.

    Further data that support the findings of this study are available in Supplementary Table 3. Full data are not publicly available as participants consented to share relevant quotes and not full interview transcripts with third parties.

    Stark, Z. Does genomic sequencing early in the diagnostic trajectory make a difference? A follow-up study of clinical outcomes and cost-effectiveness. Farnaes, L.

    Rapid whole-genome sequencing decreases infant morbidity and cost of hospitalization. French, C. Whole genome sequencing reveals that genetic conditions are frequent in intensively ill children. Intensive Care Med. Gubbels, C. Prospective, phenotype-driven selection of critically ill neonates for rapid exome sequencing is associated with high diagnostic yield. Article Google Scholar. Kingsmore, S. A randomized, controlled trial of the analytic and diagnostic performance of singleton and trio, rapid genome and exome sequencing in ill infants.

    Am J Hum Genet , — Mestek-boukhibar, L. Rapid Paediatric Sequencing RaPS : comprehensive real-life workflow for rapid diagnosis of critically ill children.

    J Med Genet 55 , — Bylstra, Y. Implementation of genomics in medical practice to deliver precision medicine for an Asian population. Damschroder, L. Clarity out of chaos: use of theory in implementation research. Psychiatry Res. Chambers, D. Convergence of implementation science, precision medicine, and the learning health care system: A new model for biomedical research. JAMA , — Roberts, M. The current state of implementation science in genomic medicine: opportunities for improvement.

    Curran, G. Effectiveness-implementation Hybrid Designs. Care 50 , — Francis, J. Health Psychol. Squires, J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Orlando, L. Levy, K. Zebrowski, A. Qualitative study of system-level factors related to genomic implementation. Sperber, N. BMC Med. Genomics 10 , 1—11 Lunke, S.

    Feasibility of ultra-rapid exome sequencing in critically ill infants and children with suspected monogenic conditions in the Australian Public Health Care System. Australian genomics: a federated model for integrating genomics into healthcare. Gaff, C. Preparing for genomic medicine: a real world demonstration of health system change.

    Meeting the challenges of implementing rapid genomic testing in acute pediatric care. Landes, S. Reprint of: an introduction to effectiveness-implementation hybrid designs. Ayres, S. Barriers and facilitators to adoption of genomic services for colorectal care within the veterans health administration. Hope-Hailey, V. Where has all the trust gone? CIPD Res. Mayer, R. Model of trust. Best, S. The leadership behaviors needed to implement clinical genomics at scale: a qualitative study.

    Brett, G. Parental experiences of ultra-rapid genomic testing for their critically unwell infants and children. Hill, M. Delivering genome sequencing for rapid genetic diagnosis in critically ill children: parent and professional views, experiences and challenges. Colquhoun, H. Chargers located in other states will have the state's corresponding club logo displayed in its place. Usage of Chargefox ultra-rapid chargers usually requires payment unless you drive an affiliated Chargefox partner EV model.

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    Post-implementation, a more complex picture emerged, with a mix of CFIR domains and constructs reported. This finding demonstrates that priorities shift over the lifetime of the project and priorities that are important early on, when creating engagement, are different to priorities for sustaining a project longer term.

    Implementation strategies will need to be adaptive 31 , dependent on the implementation phase, and implementation leaders will need to be aware of this shift in focus in order to maximize project engagement.

    Before determining appropriate implementation strategies, it is essential to consider the intended outcomes. Used alongside the effectiveness-implementation hybrid model 11 , the Conceptual Model of Implementation Research 32 Fig. Having identified the evidence based practice to implement, the next step is to identify implementation strategies, guided by practice taxonomies 33 , 34 and findings from previous studies, to address the intended outcomes, i.

    Outcomes include: 1 implementation, i. Table 1 highlights how priorities shift by professional role and phase of implementation and identifies a proposed theory-informed implementation strategy 33 with an example of how this may look, complete with the proposed outcome.

    For example, the clinical geneticists were focused on the intervention characteristics of the design quality and packaging of ultra-rapid genomic testing to ensure it is patient-centered. An implementation strategy of regular audits with feedback would provide transparent feedback on clinical outcomes and provide information on the implementation outcome of effectiveness. In the next iteration of the project, we will compile these approaches into categories e.

    Stakeholders can then be invited to rate the implementation and feasibility of the potential implementation strategies using concept mapping techniques This provides an opportunity to employ and test relevant implementation strategies, drawing on quantitative and qualitative data, while ensuring ongoing clinical efficacy.

    This study has limitations. Just over half of those invited to participate took part, and we had a clear representation across most professional roles, although there was limited input from the laboratory scientists.

    All sites participating in the Australian Genomics Acute Care program did so on a voluntary basis, and expressed high levels of implementation readiness prior to study commencement Sites that declined participation, and those that recruited relatively few patients would provide an interesting group for further study.

    Qualitative research typically involves relatively lower levels of participants than quantitative research, as it does in this case, but allows more in-depth examination of issues. Worldwide, approaches to implementation vary.

    This study was undertaken in one country, from a public healthcare system perspective, and so caution may be required when interpreting or applying these findings elsewhere. The CFIR is challenging to apply consistently in practice and is time intensive, potentially delaying the identification of findings and therefore the application of relevant intervention strategies Although our interview schedule was intentionally broad and centered on participant perceptions to promote open discussion, there were limited findings related to the CFIR domain Outer setting.

    This absence does not mean the economic, political, and social context is not relevant, as it may not typically be the immediate focus of participants such as ours. A focus on understanding this area may be of benefit in future studies. In addition, participants in this study were patient-focused and did not report costs as a barrier as costs are covered by the research study.

    The significance of resource consumption merits further detailed health economic analysis and additional investigation with both policymakers and organizational leads.

    Combining implementation science principles, genomic medicine ideals and learning healthcare system concepts is helping shape new models of care by which we can apply the findings from biomedical research and can contribute value to the rapidly evolving healthcare environment 9. Nevertheless, there are differences specific to professional roles and to implementation phases which will benefit from tailoring of implementation strategies to optimize the potential of ultra-rapid genomic testing.

    This study of professional perspectives forms an important part of the evaluation of rapid genomic testing in pediatrics and is complemented by parental experiences 29 and diagnostic outcomes The findings from these three areas will support the further development of robust, context-specific implementation strategies that can be applied and tested as we move towards sustainable healthcare system implementation. One year after the Australian Genomics Acute Care program commenced, the implementation leaders at each site identified all operational staff delivering the program, including clinical geneticists, clinical genetics trainees, genetic counselors, intensivists, project officers, and laboratory scientists.

    These staffs were invited to participate in an interview via email SB , with up to two follow-up invitation e-mails.

    Owing to slow uptake by laboratory scientists, the Acute Care program lead ZS sent one additional email to this group encouraging them to contact the lead researcher directly. Participation was voluntary and only the lead researcher SB was aware of participant identities. A cross-sectional, exploratory qualitative approach was used We designed an open semi-structured interview schedule to investigate perceptions by promoting discussion along with implementation phases.

    Questions centered on what participants expected before taking part in program delivery, how they thought the Acute Care program would fit into their current practice, reflections following implementation, and their thoughts on sustainability for the future. For consistency, one researcher SB undertook all interviews, from April to June , either face-to-face or via telephone, dependent on participant location and preference. Transcripts were de-identified, numbered and given a unique classification code by professional role clinical geneticists [CG], clinical genetics trainees [CGT], genetic counselors [GC], intensivists [I], project officers [PO], and laboratory scientists [L].

    Interview data were coded in two steps, to overcome established challenges in consistently and efficiently applying the domains and constructs of the CFIR During Step 1, two experienced qualitative researchers SB and HB undertook the mainstay of the coding and met regularly throughout data analysis to ensure internal consistency.

    Initially, ten transcripts were coded independently for the CFIR domains, and findings were compared to discuss and resolve any discrepancies. SB then completed the remainder of Step 1. Coding of the remaining constructs was then completed by SB, in ongoing consultation with HB.

    For any challenging or unresolved areas of coding, a third investigator BM was available to achieve a resolution. Implications from the commonly reported CFIR constructs were considered, including any differences by professional role and implementation phase, to identify how these findings can help inform future iterative development of the Australian Genomics Acute Care program. Further information on research design is available in the Nature Research Reporting Summary linked to this article.

    Further data that support the findings of this study are available in Supplementary Table 3. Full data are not publicly available as participants consented to share relevant quotes and not full interview transcripts with third parties.

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