Understanding Intraoperative Transfusion Decision-Making Variability: A Qualitative Study.

Area of Science:

• Anesthesiology
• Transfusion Medicine
• Health Psychology

Background:

• Significant variability exists in intraoperative red blood cell (RBC) transfusions, often unexplained by patient factors alone.
• This variability may indicate unwarranted transfusions, impacting patient safety and resource allocation.

Purpose of the Study:

• To explore the underlying beliefs of anesthesiologists and surgeons that influence intraoperative RBC transfusion decisions.
• To identify factors contributing to transfusion variability using a structured theoretical framework.

Main Methods:

• Interviews were conducted with 28 international transfusion experts (anesthesiologists and surgeons) using the Theoretical Domains Framework.
• Content analysis was performed to identify and categorize beliefs influencing transfusion decisions.

Main Results:

• Eight key domains influencing transfusion decisions were identified, including knowledge gaps, professional roles, beliefs about transfusion consequences, environmental factors, social influences, behavioral regulation needs, the nature of transfusion behavior, and decision-making processes.
• Conflicting beliefs and insufficient evidence were noted within several domains, contributing to variability.

Conclusions:

• A complex interplay of cognitive, social, and environmental factors underlies intraoperative RBC transfusion variability.
• Theory-informed interventions targeting these identified factors are needed to standardize transfusion practices and reduce unwarranted transfusions.