Assistant Professor University of Utah Salt Lake City, Utah, United States
Background/Case Studies: Transfusion guidelines were designed to decrease unnecessary transfusion and manage blood product use, however provider knowledge of and adherence to guidelines remains an issue. Transfusion utilization audit and feedback literature focuses on barriers preventing providers from adopting and adhering to transfusion guidelines. Audit and feedback (A&F) is defined as the “summary of clinical performance of healthcare over a specified time period, to provide healthcare professionals with data on performance”. Thematic analysis, a qualitative research technique, was chosen to evaluate the transfusion A&F literature and identify patterns.
Study
Design/Methods: A literature review on A&F in transfusion identified 12 articles including case studies of A&F process implementation and meta-analyses of A&F initiatives and results. Articles were reviewed and coded for recurring concepts, phrases, and findings.
Results/Findings: Thematic analysis identified 4 themes (Figure A). Themes were consistent between articles and focused on A&F challenges to observance of transfusion guidelines. A 5th theme in two articles described enablers of change.
Theme 1: Perception of Credibility. Providers questioned guideline validity and the A&F process across studies. Clinicians receiving feedback questioned how the audit was conducted, who conducted it, and utility of feedback.
Theme 2: Resistance to Change. Beliefs about the benefits of transfusion and durability of established practices contributed to resistance to change.
Theme 3: Communication. Results of audits were inconsistently communicated. In some cases, audit results weren’t shared with primary stakeholders. In other cases, A&F results were passively communicated and relied on presumptions about physician behavior.
Theme 4: Planning and Follow-Up. A&F follow-up was variable and lacked planning to integrate audit findings into performance improvements. Lack of agreement on action plans following A&F undermined the likelihood of tangible progress towards adoption of guidelines.
Theme 5: Enablers. Two articles described factors that enabled the use of A&F. Clear lines of responsibility within a hospital for how audits are conducted and how feedback was disseminated improved efficacy. Other supportive factors identified were feedback to poor performers; A&F performed by someone known to the recipient; giving both verbal and in writing feedback; and repeated feedback.
Conclusions: Audit and feedback may promote transfusion guideline adherence but thematic analysis of A&F literature identified impediments/supports to change; perception of credibility, resistance to change, communication, planning and follow-up, and enablers. A&F studies did not promote durable change to transfusion practices. Future inquiry should drill down on identified themes, focusing on resistors and enablers to change.
