Multistakeholder analysis to identify barriers and facilitators to the adoption of an innovative biomarker test for the early identification of Sepsis in hospital practice.

Background: Sepsis is a time-dependent condition with a critical course and a difficult- to-achieve diagnosis and manage medical emergency. Monocyte Distribution Width (MDW) is a new biomarker test developed by Beckman Coulter and recently validated in hospital practice for the early diagnosis of sepsis. Aim: Our study had a threefold aim: (i) map out the key stakeholders involved in the use of the new diagnostics; (ii) identify barriers and facilitators to adoption in realworld environments; (iii) inform stakeholders, health system, and public institutions to support technology adoption. Method: We adopted a two-step methodology. A systematic stakeholder mapping (step 1) identified crucial actors, which were interviewed within a semi-structured interview study (step 2). A general content analysis of the interview transcripts was undertaken, emergent themes were selected and categorized, and interviews were conducted until saturation was reached. Results: Thirty-three stakeholders were interviewed. A total of forty-eight emergent themes incorporating twenty-six adoption barriers and twenty-two facilitators were selected. The organizational change induced by the new diagnostics was identified as the most important theme for both categories. Conclusions: This study investigated multifactorial motivations of different stakeholder groups that are crucial to accelerate technology adoption. However, it is important to highlight that while most of the identified barriers may be addressed some may be absolute, e.g., the need to make the technology portable, and if recognized early in device development the investment of further resources and efforts may be avoided.