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Barriers and facilitators to implementing evidence based bleeding management in Australian Cardiac Surgery Units: a
Bronwyn L Pearse1,2,3, Samantha Keogh4,5, Claire M Rickard6,5
1School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia. bronwyn.pearse@griffithuni.edu.au.
Insights
Implementing evidence-based bleeding management in cardiac surgery requires addressing clinician capability and organizational support. Improving adherence involves standardization, training, collaboration, and supportive healthcare systems for better patient outcomes.
Area of Science:
- Cardiothoracic Surgery
- Healthcare Management
- Patient Safety
Background:
- Bleeding during cardiac surgery is a frequent complication necessitating blood product transfusion.
- Combined bleeding and transfusion increase risks of infection and mortality.
- Adherence to bleeding management guidelines is suboptimal, with unclear reasons for non-compliance.
Purpose of the Study:
- To identify barriers and facilitators to implementing evidence-based intra-operative bleeding management in Australian cardiac surgery units.
- To understand the factors influencing clinician practice and organizational implementation.
Main Methods:
- Qualitative descriptive study using semi-structured interviews.
- Participants included Australian cardiac surgeons, anaesthetists, and perfusionists.
- Theoretical Domains Framework (TDF) and COM-B model guided data collection and analysis.
Main Results:
- Nine of 14 TDF domains were significant.
- Key themes for capability: standardization, monitoring, auditing, feedback, and cross-discipline training.
- Facilitators for opportunity: collaboration, shared goals, efficient processes, and navigating healthcare financial models.
Conclusions:
- A theory-based approach identified factors influencing best practice bleeding management implementation.
- Clinician motivation exists, but healthcare organizations must partner to support change.
- Addressing identified barriers and facilitators can improve adherence and patient safety.
Background:
Bleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendations could assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based intra-operative, bleeding management in Australian cardiac surgery units.
Methods:
We used a qualitative descriptive design to conduct semi-structured interviews with Australian cardiac surgeons, anaesthetists and perfusionists. The Theoretical Domains Framework (TDF) was utilised to guide interviews and thematically analyse the data. Categorised data were then linked with the three key domains of the COM-B model (capability, opportunity, motivation - behaviour) to explore and understand behaviour.
Results:
Seventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealed key themes to improving capability included, standardisation, monitoring, auditing and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice.
Conclusion:
Using a theory-based approach it was possible to identify factors which may be positively or negatively influence clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.
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