Barriers to Implementing Internist Recommendations for Perioperative Anticoagulation Management by Surgical Teams A Qualitative Study

Main Article Content

Kristin Flemons
Michael Bosch
Gabriel Marcil
Rahim Kachra
Kelly Zarnke
Leslie Skeith
Shannon Marie Ruzycki

Keywords

Perioperative medicine, perioperative anticoagulation, implementation science, quality improvement, guideline development

Abstract

Introduction: In our center, half of all recommendations made by an internist about perioperative anticoagulation management are not followed by surgical team members. We aimed to understand the barriers to implementing perioperative anticoagulation recommendations.
Methods: This was a prespecified analysis of interviews with surgical team members about individual- and systems-level drivers of missed perioperative anticoagulation recommendations. Interviews and analysis were guided by the Theoretical Domains Framework and the Consolidation Framework for Implementation Research.
Results: We interviewed 16 surgical team members and 2 internists. Surgical team members intentionally did not follow recommendations about perioperative anticoagulation management when they felt that the bleeding risk outweighed the risk of thrombosis. This assessment of risk was driven by emotion and previous experience, even among participants who were familiar with perioperative literature.
Conclusions: Development of study outcomes and guideline recommendations for perioperative anticoagulation management should include surgical team members in order to address the acceptability of these recom-mendations and increase adoption.


Résumé
Introduction : Dans notre centre, la moitié des recommandations formulées par un interniste concernant la prise en charge de l’anticoagulation périopératoire ne sont pas suivies par les membres de l’équipe chirurgicale. Nous avons cherché à comprendre les obstacles à l’application des recommandations relatives à l’antico-agulation périopératoire.


Méthodologie : Il s’agit d’une analyse prédéterminée d’entrevues menées auprès des membres de l’équipe chirurgicale au sujet des facteurs individuels et systémiques de l’insuccès des recommandations relatives à l’anticoagulation périopératoire. Les entrevues et l’analyse ont été guidées par le Theoretical Domains Framework et le Consolidation Framework for Implementation Research.
Résultats : Nous avons interrogé 16 membres de l’équipe chirurgicale et 2 internistes. Intentionnellement, les membres de l’équipe chirurgicale ne suivent pas les recommandations concernant la prise en charge de l’anti-coagulation périopératoire lorsqu’ils estiment que le risque d’hémorragie l’emporte sur le risque de thrombose. Cette évaluation du risque est dictée par l’émotion et l’expérience antérieure, même parmi les participants qui connaissent bien la documentation du domaine périopératoire.
Conclusions : La mise en application des résultats des études et des recommandations formulées par les lignes directrices pour la prise en charge de l’anticoagulation périopératoire devrait comprendre des membres de l’équipe chirurgicale pour aborder l’acceptabilité de ces recommandations et augmenter l’adoption.

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