Physicians' perceptions of two ways of algorithm presentation: graphic versus text-based approach.

Acute bleeding during surgery or after trauma harms patients, and challenges involved physicians. Protocols and cognitive aids can help in such situations. This dual-centre study investigated physicians' opinions regarding two ways to present cognitive aids, graphic 'Haemostasis Traffic Light' and text-based, using the example of a coagulation management algorithm to identify the strengths and limitations of both presentation modalities. Using qualitative research methods, we identified recurring answer patterns and derived major topics and subthemes through inductive coding. Eighty-four physicians participated. We assigned each half randomly to one of the cognitive aids (graphic/text-based) and determined 447 usable statements. We qualitatively deduced the importance of having a cognitive aid for physicians. Furthermore, it is noticeable that the graphic group made more positive comments (154 of 242 (64%) statements), while the text-based participants made more negative annotations (126 of 205 (61%) statements), suggesting a generally stronger approval of this cognitive aid. Practitioner summary: This qualitative study provides an overview of physicians` positive and negative perceptions regarding two presentation ways for a coagulation management algorithm. Participants perceived the graphic method created according to user-centred design principles more positively. The analysis reveals components that an ideal algorithm should have to help streamline the decision-making process.

Physicians' perceptions regarding acute bleeding management: an international mixed qualitative quantitative study.

BACKGROUND: Acute bleeding is an omnipresent challenge for all physicians. Uncontrolled hemorrhage is the most common preventable cause of death after trauma worldwide. In different surgical disciplines, hemorrhage represents an independent risk factor for increased postoperative morbimortality, directly affecting patients' outcomes. This study asked anesthesiologists about their personal perceived challenges when treating bleeding patients. METHODS: This investigator-initiated, prospective, international, dual-center, mixed qualitative and quantitative study interrogated anesthesiologists about what they found easy and what difficult in treating acutely bleeding patients. Following the template approach for qualitative research, we identified major and minor topics through free inductive coding and word count. In a second step, we derived ten statements from the participants' answers. Using a field survey, we then asked the participants to rate their level of agreement with the derived statements. We analyzed the answers using one sample Wilcoxon test and the Mann-Whitney test. RESULTS: We included a total of 84 physicians in the qualitative interrogations and a different group of 42 anesthesiologists in the quantitative part. We identified 11 major topics and 19 associated subtopics. The main topics and the degree of agreement (here as agree or strongly agree) were as follows: "Complexity of the topic" (52.4% agreed to find the topic complex), "Cognitive aids" (92.9% agreed to find them helpful), "Time management" (64.3% agreed to feeling time pressure), "Human factors" (95.2% agreed that human factors are essential), "Resources" (95.2% agreed that resources are essential), "Experience" and "Low frequency of cases" (57.1% agreed to lack practice), "Diagnostic methods" (31.0% agreed that the interpretation of test results is difficult), "Anticoagulation" (85.7% agreed to it being difficult), "Treatment" (81.0% agreed to knowing the first therapeutic steps), and "Nothing". CONCLUSIONS: Anesthesiologists in two large tertiary care facilities in different parts of the world found coagulation management, especially in anticoagulated patients, complex. We identified the delayed diagnostic test results and their interpretation as challenges. Resources, treatment protocols and human factors such as team communication were perceived to facilitate management. Future studies should explore the challenges in smaller hospitals and other parts of the world and test new technologies addressing the identified difficulties.

Intraoperative Hemostatic Management of a Cardiohepatic Transplant With Rotational Thromboelastometry: A Case Report.

Cardiohepatic transplantation represents a double hemostatic challenge. Given the absence of specific guidelines and current evidence, we designed a 5-step approach based on rotational thromboelastometry (ROTEM). A 60-year-old male patient with cirrhosis and myocarditis underwent a 9-hour transplantation. Bleeding occurred after weaning from extracorporeal circulation. Evidence of reduced clot strength triggered fibrinogen and platelet replacement therapy. During liver transplant, only hemoglobin optimization was necessary. In conclusion, hemostatic management protocols for cardiohepatic transplants should consider the specific coagulopathy mechanisms underlying each surgical phase. Because whole blood testing is essential for their diagnosis, we recommend using ROTEM for optimal coagulation management.