Bleeding Management Practices of Australian Cardiac Surgeons, Anesthesiologists and Perfusionists: A Cross-Sectional National Survey Incorporating the Theoretical Domains Framework (TDF) and COM-B Model

Abstract

Bronwyn L Pearse, 1–3 Samantha Keogh, 4, 5 Claire M Rickard, 1, 5 Daniel J Faulke, 2 Ian Smith, 2 Douglas Wall, 3 Charles McDonald, 2 Yoke L Fung 6 1School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia; 2Department of Anaesthesia and Perfusion, The Prince Charles Hospital, Chermside, QLD, Australia; 3Department of Cardiac Surgery, The Prince Charles Hospital, Chermside, QLD, Australia; 4School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, Australia; 5Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia; 6School of Health and Sports Sciences, University of Sunshine Coast, Sunshine Coast, QLD, AustraliaCorrespondence: Bronwyn L PearseDepartment of Anaesthesia and Perfusion, The Prince Charles Hospital, Chermside, QLD, AustraliaTel [phone]Fax [phone]Email [email protected]: Excessive bleeding is an acknowledged consequence of cardiac surgery, occurring in up to 10% of adult patients. This clinically important complication leads to poorer patient outcomes. Clinical practice guidelines are available to support best practice however variability in bleeding management practice and related adverse outcomes still exist. This study had two objectives: 1) to gain insight into current bleeding management practice for adult cardiac surgery in Australia and how that compared to guidelines and literature; and 2) to understand perceived difficulties clinicians face implementing improvements in bleeding management.Methods: A national cross-sectional questionnaire survey was utilized. Perspectives were sought from cardiac surgeons, cardiac anesthesiologists and perfusionists. Thirty-nine closed-ended questions focused on routine bleeding management practices to address pre and intra-operative care. One open-ended question was asked; “What would assist you to improve bleeding management with cardiac surgery patients?” Quantitative data were analysed with SPSS. Qualitative data were categorized into the domains of the Theoretical Domains Framework; the domains were then mapped to the COM-B model.Results: Survey responses from 159 Anesthesiologists, 39 cardiac surgeons and 86 perfusionists were included (response rate 37%). Four of the recommendations queried in this survey were reported as routinely adhered to < 50% of the time, 9 queried recommendations were adhered to 51– 75% of the time and 4 recommendations were routinely followed > 76% of the time.Conclusion: There is a wide variation in peri-operative bleeding management practice among cardiac anaesthesiologists, surgeons and perfusionists in Australian cardiac surgery units. Conceptualizing factors believed necessary to improve practice with the TDF and COM-B model found that bleeding management could be improved with a standardized approach including; point of care diagnostic assays, a bleeding management algorithm, access to concentrated coagulation factors, cardiac surgery specific bleeding management education, multidisciplinary team agreement and support, and an overarching national approach.Keywords: bleeding, cardiac surgery, clinical practice guidelines, multidisciplinary, theoretical domains framework, implementation

Keywords

• bleeding
• cardiac surgery
• clinical practice guidelines
• multidisciplinary
• theoretical domains framework
• implementation