Clinical decision support versus a paper-based protocol for massive transfusion: Impact on decision outcomes in a...

Area of Science:

• Medical Informatics
• Emergency Medicine
• Clinical Decision Support Systems

Background:

• Major hemorrhage management often necessitates massive transfusion (MT) protocols.
• A user-centered design approach yielded a clinical decision support (CDS) system for MT.
• This study evaluates the impact of the CDS during MT administration.

Purpose of the Study:

• To compare the effectiveness of a CDS for MT against a paper-based protocol in simulated hemorrhage scenarios.
• To assess decision velocity, task completion, and cognitive workload.
• To evaluate the usability of the CDS.

Main Methods:

• A randomized simulation trial involving 44 critical care specialists, residents, and nurses.
• Two 20-minute simulated bleeding scenarios were conducted.
• Outcomes measured included decision velocity, task completion, cognitive workload, and System Usability Scale (SUS).

Main Results:

• CDS-based management significantly increased decision velocity (8.5 vs. 6.9 decisions/hour; p=0.003).
• Overall task completion was similar between CDS and paper-based protocols (13.3 vs. 13.2; p=0.92).
• Cognitive workload was significantly lower with CDS (mean 57.1 vs. 64.5; p=0.005), with a SUS score of 82.5.

Conclusions:

• CDS-based MT management enhances decision-making efficiency, particularly for users with limited training.
• The CDS achieves comparable task completion to paper protocols while reducing cognitive burden.
• Further clinical implementation is needed to confirm patient outcome improvements.