Perceived barriers and facilitators to implementing a consensus-based same-day discharge post-percutaneous coronary intervention clinical pathway in Queensland, Australia

Abstract

To identify perceived barriers and facilitators to an intended adoption of aconsensus-based same-day discharge (SDD) clinical guideline for patients undergoing elective percutaneous coronary intervention (PCI). This qualitative study was conducted in six cardiac catheterisation suites of public hospitals in Queensland, Australia. Semi-structured interviews were undertaken with clinicians, patients, and carers between July and October 2024. Interviews were recorded and transcribed. Inductive content analysis was performed before themes were mapped deductively against the Theoretical Domains Framework (TDF). A total of 22 participants (doctors [n = 10], nurses [n = 8], patients [n = 2], and carers [n = 2]) participated in interviews. Six domains, including knowledge, social/professional role and identity, environmental contexts and resources, beliefs about consequences, memory, attention, and decision-making, and beliefs about capabilities, were strongly related to the factors that influenced the implementation. The findings revealed perceived main barriers to the implementation, including logistical (e.g., geographical considerations), professional (e.g., resistance to change), and hospital reimbursement models that unfavoured SDD. The main drivers were effective leadership, benchmarking among hospitals, inter-hospital consultation and collaboration, having a designated champion, and targeted education sessions for clinicians, patients, and carers. Findings suggest that adopting this consensus-based SDD clinical guideline has multifactorial and interrelated influences. The identification of the barriers across various TDF domains provides opportunities to develop effective implementation strategies to facilitate SDD implementation. This study highlights the need for multifaceted approach to implementing SDD. Leaders in public health policy and organisations must consider a range of interconnected influences for effective implementation and sustained adherence.