Qualitative assessment of facilitators and barriers to testicular torsion care: Findings from the testicular torsion collaborative

Background Testicular torsion is a well-documented pediatric urological emergency that poses a time-sensitive risk to the testicle and long-term morbidity. Despite the urgent nature of testicular torsion, few studies have explored the institutional and clinical factors that influence diagnosis and management. To address this gap, we performed qualitative focus group interviews across the National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Collaborative to better understand facilitators and barriers to testicular torsion care. Methods Relevant stakeholders involved in testicular torsion care (i.e. emergency department, radiology, urology, peri-operative services, anesthesia, and surgical quality leadership) across the Testicular Torsion Collaborative were invited to participate in focus group interviews led by a moderator and included a note-taker. All focus groups were recorded and transcribed via Zoom™ audio-visual conferencing software. Inductive coding was performed by 3 reviewers using Dedoose (Los Angeles CA). Themes were designated within the Theoretical Domain Framework (TDF) construct for implementation science and determined to be either a facilitator or barrier to testicular torsion care. Results Of the 29 invited sites, 10 sites and 47 individuals participated. Thematic saturation was reached for 20 themes, each represented in at least 2 focus group discussions. All elements of the TDF were represented in the discussions. Community education, culture of quality, high standard of care expectations, and leveraging available data were universally seen as facilitators. Long term follow-up and outcomes, manual detorsion care, and competing care demands were universally seen as barriers. Conclusions Based on focus groups of stakeholders in all aspects of testicular torsion care, opportunities to improve care include leveraging quality improvement culture and resources (i.e. trained personnel, data). Barriers to care include competing care demands arising from outside transfers and institutional clinical volume. We hope readers can use this data as a framework to improve in testicular torsion care.