Table 2.

Respondent Perceptions of Requirements to Improve Bleeding Management Practice

COM-B	TDF Domains	Themes	Example Quotations	Frequency Out of 99
Capability	Behavioural Regulation	Standardization	“A more structured approach to bleeding” A “Blood product availability should not be unit dependent for institutions within the same state or territory. Every blood bank at every hospital has different process for providing blood products” P “Need consistency in approach between different surgeons and ICU clinicians” A “Our local algorithm included in an app to make it easy to follow” A “Minimise haemodilution in the first place, is the most important strategy” S	16
	Knowledge	Cardiac surgery specific bleeding management education/guidelines	“Online CPD courses specifically looking at bleeding in cardiac surgical patients” A “National guidelines which set a standard for blood product administration based on a single ROTEM algorithm accepted nationally rather than unit based” P “Some evidence-based bleeding management guidelines would be helpful” P “National guidelines would allow us to push past local funding and political problems” A “More and more education” A	13
Opportunity	Environmental Context and Resources	Access to point of care diagnostic assays (ROTEM/TEG & Multiplate)	“Better POCCT availability (i.e. rapid)” P “ROTEM ± Multiplate in MOT” A “I believe we should be using point of care thromboelastography with a panel of tests” A “Easy point of care access to TEG/ROTEM” “ROTEM, Multiplate and vWF assays” S “Better availability of Multiplate analysis” A “Better point of care assessment - rapid response time” A “Need Multiplate, ROTEM” P “The availability of TEG has changed our management” A “ROTEM or equivalent in theatre itself” S	20
		Dedicated blood management support clinicians	“I expect it would not be a viable business model, but it would be novel and helpful to have a separate and properly trained transfusion expert to manage massive bleeding” A “Blood management nurse support” A “Transfusion nurse onsite” A “More blood management nurses” S	15
		Decision support tool for bleeding management (algorithm/app)	“Standardized ROTEM guided algorithm” A “Algorithms” P “Decisions guided by an algorithm/app approved and adopted nationally” A “ROTEM/Multiplate interpretation app” S “An agreed protocol for the bleeding patient would be useful” A “App would be useful, including doses, (on/kg basis)” A	9
		Access to fibrinogen concentrate	“Fibrinogen concentrate” A “Fibrinogen concentrate more readily available” A “Availability of more specific factors such as fibrinogen concentrate” S “Availability of FC” A	6
	Social Influences	Multidisciplinary team contribution	“Combined cardiac surgery, cardiac anaesthesia, intensive care and haematology consensus on management with emphasis on point of care testing” P “An awareness by cardiologists re their impact on potential post op bleeding in acute patients” S “Needs to be multi-disciplinary to work” P “I would like the intensivists to be more interested” A “We have a good response at this hospital, with good advice from Haematology” A “If the various departments (cardiac, surgery, anaesthesia, ICU and blood bank) could actually work together” A “Haematologist with experience in acute bleeding” A “More awareness from everyone involved - ICU, surgeons, hospital administration” S “Need a co-ordinated blood management program” A “A haematologist that answers the phone” S	12
Motivation	Beliefs about capability	Control (or lack of) over ability to effectively manage bleeding	“We have the best available tools and agents available to us for routine use” A “Too many times tests are performed, and the results are either ignored or not considered in the management of post-operative bleeding” P “We have a documented strategy for dealing with bleeding that includes administration of platelets. cryoprecipitate and desmopressin. Factor VII is only used when surgical bleeding continues beyond reasonable use of blood products” P “Better blood bank support for peripheral hospitals” S “It is frequent to have a normal ROTEM in the bleeding post-op patient, but blood products are given anyway as opposed to discussion about surgical intervention” A	8

Abbreviations: S, Surgeon; A, Anesthesiologist; P, Perfusionist.