Abstract
BackgroundBleeding 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.MethodsWe 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.ResultsSeventeen 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.ConclusionUsing 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.
Highlights
Bleeding during cardiac surgery is a common complication that often requires the transfusion of blood products
In 2010, the implementation of multidisciplinary and multimodal concepts to manage bleeding and blood loss were endorsed by the World Health Organisation (WHO) as part of the Patient Blood Management paradigm (PBM) [19]
Design This study employed a qualitative design to investigate the perceptions of barriers and facilitators to practicing and implementing bleeding management in Australian cardiac surgery units
Summary
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. Excessive bleeding occurs during and after cardiac surgery in up to 10% of patients; and the most common treatment is the transfusion of blood products [1, 2]. The combination of excessive bleeding, management with blood transfusion and re-exploration surgery incrementally increases adverse outcomes including infection and mortality [6,7,8,9,10,11,12,13]. The complex and dynamic context of cardiac surgery makes the implementation of bleeding management a genuine challenge for the surgical team. The significant variation in bleeding management practice and outcomes noted in literature may be a result of these managing these challenges [1, 20,21,22,23]
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