Barriers to High-quality Postoperative Glycemic Management by Surgical Teams: A Theory-informed Qualitative Analysis

Kristin Flemons; Anna Cameron; Lesly Dossett; Karmon E Helmle; Julie McKeen; Shannon M Ruzycki

doi:10.1016/j.jcjd.2023.05.001

Barriers to High-quality Postoperative Glycemic Management by Surgical Teams: A Theory-informed Qualitative Analysis

Can J Diabetes. 2023 Oct;47(7):560-565. doi: 10.1016/j.jcjd.2023.05.001. Epub 2023 May 15.

Authors

Kristin Flemons¹, Anna Cameron², Lesly Dossett³, Karmon E Helmle⁴, Julie McKeen⁴, Shannon M Ruzycki⁵

Affiliations

¹ W21C, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Department of Surgery, University of Michigan, Ann Arbor, Michigan, United States.
⁴ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: shannon.ruzycki@ucalgary.ca.

PMID: 37196982
DOI: 10.1016/j.jcjd.2023.05.001

Abstract

Objective: Our aim in this study was to identify the barriers to following recommendations for postoperative glycemic management among surgical team members.

Methods: We conducted semistructured interviews with surgical team members guided by 2 theoretical frameworks for understanding the barriers and drivers of health-care behaviours: the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. Interview data were coded deductively by 2 study team members.

Results: Sixteen surgical team members from 7 surgical disciplines at a single hospital participated in this investigation. The most important barriers to management of postoperative hyperglycemia were knowledge of glycemic targets, belief about consequences of hyper- and hypoglycemia, available resources to manage hyperglycemia, adaptability of usual insulin regimens to complex postoperative patients, and skills to initiate insulin.

Conclusions: Interventions to reduce postoperative hyperglycemia are unlikely to be effective unless they use implementation science to address local barriers to high-quality management among surgical team members, including setting and systems-level barriers.

Keywords: amélioration de la qualité; amélioration de la qualité chirurgicale; analyse qualitative; diabète hospitalier; gestion glycémique périopératoire; hyperglycémie périopératoire; in-hospital diabetes; perioperative glycemic management; perioperative hyperglycemia; qualitative analysis; quality improvement; surgical quality improvement.