Research Article – BMC Health Service Research (IF -1.93) 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

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 recommendationscould 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 bleeding management in Australian cardiac surgery units. MethodsWe used a qualitative descriptive design to conduct semi-structuredinterviews with Australian cardiac surgeons, anaesthetists and perfusionists.The Theoretical Domains Framework (TDF) was utilised toguide interviews and thematically analyse the data. Categorised data were then linkedwith the three key domains of the COM-B model (capability, opportunity, and motivation) to explore and understand behaviour.ResultsSeventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealedkey themesto improving capabilityincluded, 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 approachit was possible to identifyfactors which may be positively or negatively influencing clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.