title: Factors influencing the adoption of blood alternatives to minimize allogeneic transfusion: the perspective of eight Ontario hospitals.
abstract: OBJECTIVE
  To identify and describe the factors influencing the use and nonuse of blood-sparing methods such as preoperative autologous donation, acute normovolemic hemodilution, and the use of cell salvage devices, hemostatic agents and erythropoietin.
  
  
  METHODS
  An interview survey.
  
  
  METHODS
  Eight Ontario hospitals.
  
  
  METHODS
  Interviews were conducted with chiefs of surgery, orthopedics, cardiac surgery and anesthesia, and with heads of transfusion medicine and pharmacy. Hospitals were selected using the qualitative sampling strategy of maximum variation based on their use of the methods (as reported in a previous mail survey).
  
  
  RESULTS
  Use of blood-sparing methods was influenced by diverse factors often operating simultaneously. These included the following: characteristics of the method (e.g., evidence of its effectiveness, ease of use, cost); perceptions and experiences of the potential adopters (experience with the method, perception of the current safety of allogeneic blood, perceived convenience or inconvenience of using the method); aspects of the practice setting (inability to move resources between hospital departments, presence of a local clinical champion); and the external environment (patient and public expectations, funding of the blood system, blood shortages).
  
  
  CONCLUSIONS
  More rational and evidence-based use of blood-sparing methods could be promoted by the adoption of an interdisciplinary, comprehensive, coordinated approach tailored to each patient's needs.
authors.affiliation: Clinical Epidemiology Unit, Loeb Health Research Institute, Ottawa, Ont. igraham@lri.ca
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Alvarez
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Tetroe
authors.forename: Laura
authors.initials: L
authors.lastname: McAuley
authors.forename: Andreas
authors.initials: A
authors.lastname: Laupacis
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data*; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario