Preoperative anaemia screening and treatment: Barrier identification and implementation strategy mapping

Abstract

Background: Patients undergoing major surgery are at risk of significant blood loss and subsequent transfusion, which increases substantially if the patient has pre-existing anaemia. Preoperative anaemia screening and treatment pathways (PAST-P) outline recommended blood tests and treatment to ensure patient optimisation before surgery. Although documented success in using PAST-P to reduce transfusions and improve patient outcomes exists, the reporting quality of such studies is suboptimal, and it remains unclear what implementation strategies best support the implementation of PAST-P. This study uses qualitative methods to identify local barriers and maps them to recommended implementation strategies.Method: Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients. Qualitative data was collected using semi-structured interviews. Data analysis utilised a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. The Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection.Results: The analysis revealed ten barriers: external policy and incentives, patient needs and resources, structural characteristics, networks and communications, relative priority, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy and executing. ERIC strategies recommended to mitigate barriers are: conduct educational meetings, develop educational materials, distribute educational materials, access new funding, promote network weaving, organise clinician implementation team meetings, obtain and use patients/consumers/family feedback, involve patients/consumers/family members and conduct a local needs assessment.Conclusion: Five of ten identified barriers had strong recommendations, and nine implementation strategies were identified as being suitable to address them. Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAST-P, once it is launched at the study hospital.