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. 2021 Jun 5;21(1):550.
doi: 10.1186/s12913-021-06269-8.

Barriers and facilitators to implementing evidence based bleeding management in Australian Cardiac Surgery Units: a qualitative interview study analysed with the theoretical domains framework and COM-B model

Bronwyn L Pearse  1   2   3 , Samantha Keogh  4   5 , Claire M Rickard  6   5 , Yoke L Fung  7
Affiliations

Barriers and facilitators to implementing evidence based bleeding management in Australian Cardiac Surgery Units: a qualitative interview study analysed with the theoretical domains framework and COM-B model

Bronwyn L Pearse et al. BMC Health Serv Res. .

Abstract

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.

Keywords: Australia; Barriers; Bleeding; COM-B model; Cardiac surgery; Facilitators; Theoretical domains framework.

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Conflict of interest statement

Competitive grant funding to complete this study was received from the Australian National Blood Authority R&D program. Griffith University has received unrestricted investigator-initiated research or educational grants on CMR’s behalf from: BD-Bard and Cardinal Health). Griffith University has received consultancy payments on CMR’s behalf from: 3 M, BBraun, BD-Bard. SK’s current and previous employer have received monies on her behalf from 3 M and BD for research and educational consultancies, investigator-initiated grants, and unrestricted grants in aid. The authors report no other conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Explanatory themes describing the barriers and facilitators to practicing and implementing evidence-based bleeding management in Australian Cardiac Surgery Units
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