Understanding the determinants of blood use in orthopaedics: A review of the literature and a theory based exploration of the factors influencing the decision to transfuse

Abstract

Inappropriate transfusions overexpose patients to the risk of transfusions. The objective of this thesis was to better understand the determinants of watching and waiting instead of transfusing red blood cells among orthopaedic surgeons using 1) a systematic review of interventions to reduce inappropriate transfusions; 2) interviews with orthopaedic surgeons; and 3) a theory based predictive survey of transfusion intentions and behaviour. The results of the systematic review suggest that the literature is insufficient to determine the effectiveness of interventions designed to reduce inappropriate blood transfusions. The interviews with surgeons identified six theories potentially relevant to our behaviour. The analysis of the survey identified the Theory of Planned Behaviour as the best predictor of intention to transfuse, accounting for 37% variation. These findings can be used to support the development of a theory based knowledge translation intervention to improve appropriate use of blood transfusions by Canadian orthopaedic surgeons.