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Evidence-based practice in Interventional Radiology: A mixed methods study exploring how evidence is incorporated into practice with a particular focus on blood glucose requirements for vascular patients with peripheral artery disease undergoing peripheral angioplasty.

Abstract
Background: Evidence-based practice was established to align patient care with the best available evidence. At Waikato Hospital, vascular patients undergoing peripheral angioplasty are required to have a pre-procedural blood glucose level of less than 11 mmol/L. However, there is no guideline outlining this requirement or the underlying evidence supporting this criterion, the absence of which has led to confusion amongst staff. This research project seeks to explore how evidence for pre-procedural blood glucose requirements for vascular patients undergoing peripheral angioplasty is incorporated into practice and how the evidence is disseminated to relevant services. Participants: The quantitative phase reviewed the clinical records of vascular patients (n=93) who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year. Due to incomplete datasets, a total of 50 patient clinical records were included in analysis. The qualitative phase involved interviews with health professionals (n=9) involved in the care of vascular patients undergoing peripheral angioplasty. Methods: This mixed-methods two-phase research project involved an initial retrospective clinical records audit of vascular patients diagnosed with diabetes mellitus who had undergone a peripheral angioplasty in the 2022 – 2023 calendar year. A regression analysis was undertaken to determine the correlation between the change in creatinine levels and (i) patient diagnoses and (ii) pre-procedural blood glucose levels. Qualitative data were gathered through semi-structured interviews with health professionals. These interviews were analysed using a general inductive method of inquiry to identify key overarching themes. Findings: There was no observed statistically significant association using ANOVA between the change in creatinine levels and patient diagnoses (p=0.31) or pre-procedural blood glucose levels in vascular patients following a peripheral angioplasty (p=0.14). Although a one-unit increase in pre-procedural blood glucose levels was observed to result in an associated increase of 3.5 mg/dL in creatinine levels, this was not statistically significant (p=0.25). Analysis of the qualitative interview data from interviews with health professionals produced three themes relating to the implementation of evidence-based practice: (i) Dissemination of evidence; (ii) Balancing practicality with evidence in healthcare delivery; and (iii) Enhancing evidence-based practice in clinical contexts. Conclusion: Although the research reported a relationship between raised pre-procedure blood glucose and creatinine levels, it was not statistically significant. More meaningful results arose, however, from the stakeholder interviews, which indicated a lack of communication and support around the rationale for the pre-procedural blood glucose cut-off value. It appeared that such miscommunication would be absent through the investment into staff education and the development of a clinical guideline.
Type
Thesis
Type of thesis
Series
Citation
Date
2023
Publisher
The University of Waikato
Supervisors
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