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

Tadzio R Roche1, Doreen J Wetli1, Julia Braun2

  • 1Institute of Anesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.

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Summary
This summary is machine-generated.

Anesthesiologists find managing acute bleeding complex, particularly with anticoagulated patients. Cognitive aids, resources, and team communication are crucial for effective treatment.

Keywords:
Acute bleedingAlgorithmsCoagulation managementDecision makingDiagnosticsQualitative researchSurvey and questionnairesTreatment

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Area of Science:

  • Anesthesiology
  • Hemorrhage Management
  • Patient Safety

Background:

  • Acute bleeding is a significant challenge in medicine, with uncontrolled hemorrhage being a leading cause of preventable death globally.
  • Hemorrhage is an independent risk factor for increased postoperative morbidity and mortality across surgical disciplines.
  • This study investigates the perceived challenges anesthesiologists face when managing patients with acute bleeding.

Purpose of the Study:

  • To identify and analyze the specific difficulties encountered by anesthesiologists in treating acutely bleeding patients.
  • To explore factors that facilitate or hinder effective hemorrhage management.
  • To gather insights for improving clinical practice and future research in bleeding management.

Main Methods:

  • A mixed-methods study involving qualitative interrogations and quantitative field surveys of anesthesiologists.
  • Utilized template approach for qualitative research, including free inductive coding and word count analysis.
  • Derived and rated agreement with ten statements based on participant feedback, analyzed using Wilcoxon and Mann-Whitney tests.

Main Results:

  • A majority of anesthesiologists found managing anticoagulated patients complex (85.7% agreement).
  • Key challenges included cognitive load, time pressure, and difficulties with diagnostic test interpretation (31.0% agreement).
  • Cognitive aids (92.9%), human factors like team communication (95.2%), and resource availability (95.2%) were identified as essential facilitators.

Conclusions:

  • Anesthesiologists perceive coagulation management, especially in anticoagulated patients, as complex.
  • Delayed diagnostic test results and their interpretation pose significant challenges.
  • Resources, treatment protocols, and effective team communication are vital for successful hemorrhage management.