Utilizing qualitative research to improve clinical outcomes.

Posted on January 16, 2020

The fundamental purpose of qualitative research is to understand better why a particular group behaves as it does. The numbers produced by quantitative research only scratch the surface of these types of questions, being more about learning which sub-groups are essential and how much they may vary in behaviors and responses. In comparison, qualitative research is much better at getting at the ‘hows’ and ‘whys’ that are so important to in-depth knowledge.

First, you select a particular population to study. It can be any group with some level of shared experience. Second, you need to collect some free-form data from (or about) a representative sample of that population. Third, you want to record any potentially relevant information about the sources of that data: age, ethnicity, sex, previous ailments – you name it. Fourth, it is time to highlight the most relevant sections of that qualitative data, have a preliminary perhaps coding each excerpt for the degree to which it supports or refutes a particular theme. These themes can be questions you now want to investigate upfront or questions that the excerpts themselves suggest during your study. This step will be based mainly on the project’s research methodology. If any CCS perfusionists are interested in formulating a study or wish to discuss examining a specific study group, please reach out to Professor Gunaydin or me at any time.

We thought this week’s topic would cover our recent pediatric study and publication, and we hope you enjoy the reading. A STRUCTURED BLOOD CONSERVATION PROGRAM IN PEDIATRIC CARDIAC SURGERY: More Is Better”

Background: The limitation of alternative transfusion practices in infants increases the benefits of blood conservation. We analyzed the efficacy of a structured program to reduce transfusions and transfusion-associated complications in cardiac surgery

Methods: Our pediatric surgery database was reviewed retrospectively, comparing outcomes from two different time periods, after the implementation of an effective blood conservation program beginning in March 2014.  A total of 214 infants (8.1±3.4 months) who underwent biventricular repair utilizing CPB (Group1-Blood conservation) were studied in 12 months (March 2014-February 2015) after the implementation of the new program and compared with 250 infants (7.91±3.2 months) (Group 2-Control-No blood conservation) of the previous 12-month period (March 2013-February 2014).

Results: The proportion of patients transfused with red blood cells was 75.2% (N=188) in the control group and reduced by 16.4% in the study group (58.8%- 126 patients, p <0.01). The mean number of transfusions was 1.25 ± 0.5 units per patient in the control group and decreased to 0.7 ± 0.5 units per patient after the start of the program (P = 0.035). Cerebral oximetry demonstrated better follow-up during the operative period confirming less hemodilution in Group 1. Respiratory support, inotropic need, and ICU stay were significantly better in the study group.

Conclusion: These findings, in addition to attendant risks and side effects of blood transfusion and the rising cost of safer blood products, justify blood conservation in pediatric cardiac operations. Circuit miniaturization, ultrafiltration, and reduced postoperative bleeding, presumably secondary to higher fibrinogen and other coagulation factor levels, contributed to this outcome.

Kevin McCusker Ph.D., MSc., CCP
Assistant Professor of Surgery
New York Medical College
Valhalla, New York 10575                                                          

Serdar Gunaydin M.D., Ph.D.
Professor of Surgery
University of Health Sciences
Ankara, Turkey

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