This thesis used a scoping review to identify the main themes underpinning unnecessary
routine blood tests in the critically ill. These themes were developed further in a workshop
with key stakeholders from an intensive care unit case study. Finally, key themes were
further developed into recommendations for local and national guidelines regarding routine
blood tests in the critically ill and to propose a set of core outcome measures for future
research in this area.
Blood tests, which are routinely conducted in critically ill patients, have been proven to be
associated with adverse outcomes such as; iatrogenic anaemia, increased likelihood of
blood product transfusion, increased length of stay and increased mortality. By definition
these are ‘routine’ and form part of the norms and culture within an intensive care unit; it is
therefore important to thoroughly explore the underpinning rationale and behaviours before
developing strategies to attempt to change it.
To establish what is already known on this subject a scoping review of the literatures was
conducted in accordance with the six-stage approach as set out by (Arksey & O'Malley,
2003) (Levac, Colquhoun, & O'Brien, 2010). Thematic analysis was conducted on the 17
articles included in the scoping review. The following key themes were identified: patient
centred outcomes, costs associated with unnecessary blood tests, behaviours and
rationale underpinning routine blood tests, and strategies to reduce routine blood tests in
the critically ill.
These 4 themes were then used to inform a workshop with key stakeholders to help
understand workplace culture and the factors influencing behaviours, using a single
intensive care unit as a case study. Co-production theory was integrated into the design
and conduct of the workshop, to explore the utility of this approach in qualitative health
research methodology. The 4 themes from the scoping review were validated during the
workshop.
Following the workshop the 5 themes were analysed utilising positioning theory to draw
conclusions and recommendations including the development of local and national
guidelines.
It was concluded that the mixed methods approach; incorporating a scoping review to
inform a workshop employing co-production theory, and analysis using positioning theory,
was a useful model to explore behaviours in a medical context.