Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Roche TR

PROVIDER: S-EPMC7874660 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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

Roche Tadzio R TR Wetli Doreen J DJ Braun Julia J Kataife Ezequiel D ED Mileo Federico G FG Spahn Donat R DR Tscholl David W DW Said Sadiq S

BMC anesthesiology 20210210 1

<h4>Background</h4>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.<h4>Methods</h4>This investigator-initiated, pro ...[more]

PMID: 33568050

Similar Datasets

Project description:BackgroundThe efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs) perceptions of academic detailing and the factors that affect their use of it.MethodsWe used 2 methods to collect data, a questionnaire and semi-structured telephone interviews. We mailed questionnaires to all FPs in the Dalhousie Office of Continuing Medical Education database and analyzed responses of non-users and users of academic detailing. After a preliminary analysis of questionnaire data, we conducted semi-structured interviews with 7 FPs who did not use academic detailing and 17 who did use it.ResultsOverall response rate to the questionnaire was 33% (289/869). Response rate of non-users of academic detailing was 15% (60/393), of users was 48% (229/476). The 3 factors that most encouraged use of academic detailing were the topics selected, the evidence-based approach adopted, and the handout material. The 3 factors that most discouraged the use of academic detailing were spending office time doing CME, scheduling time to see the academic detailer, and having CME provided by a non-physician. Users of academic detailing rated it as being more valuable than other forms of CME. Generally, interview data confirmed questionnaire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier. Interview informants mentioned that the evidence-based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs, pharmaceutical representatives, and journal articles, but not advice from specialists.ConclusionUsers of academic detailing highly value its educational value and tend to view information from other sources more critically because of its evidence-based approach. Non-users are unlikely to adopt academic detailing despite its high educational value because they find using office time for CME too much of a barrier. To reach these physicians with academic detailing messages, we will have to find other CME formats.

Project description:BACKGROUND:Experience with open disclosure and its study are restricted to certain western countries. In addition, there are concerns that open disclosure may be less suitable in non-western countries. The present study explored and compared the in-depth perceptions of the general public and physicians regarding open disclosure in Korea. METHODS:We applied the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist to this qualitative study. We conducted 20 in-depth interviews and four focus group discussions with 16 physicians and 18 members of the general public. In-depth interviews and focus group discussions were performed according to semi-structured guidelines developed according to a systematic review of open disclosure. We conducted a directed content analysis by analyzing the verbatim transcripts and field notes in accordance with the predetermined guidelines. RESULTS:Open disclosure perceptions were summarized in terms of the "five Ws and one H" (who, what, where, when, why, and how). All physician and general public participants acknowledged the normative justifiability of open disclosure. The participants mostly agreed on the known effects of open disclosure, but the physicians had negative opinions on its expected effects, such as decreased intention of the general public to file lawsuits and increased credibility of medical professionals. Generally, the participants thought that open disclosure is required for medical errors causing major harm. However, the physicians and general public had conflicting opinions on the need for open disclosure of near misses. Most physicians did not know how to conduct open disclosure and some physicians had bad experiences due to inappropriate or incomplete open disclosure. CONCLUSION:Physicians and the general public in Korea acknowledge the need for open disclosure. Guidelines according to the type of patient safety incident are required to encourage physicians to more readily conduct open disclosure. Furthermore, hospitals need to consider organizing a dedicated team and hiring experts for open disclosure.

Project description:BackgroundA new patient monitoring technology called Visual Patient, which transforms numerical and waveform data into a virtual model (an avatar) of the monitored patient, has been shown to improve the perception of vital signs compared to conventional patient monitoring. In order to gain a deeper understanding of the opinions of potential future users regarding the new technology, we have analyzed the answers of two large groups of anesthetists using two different study methods.MethodsFirst, we carried out a qualitative analysis guided by the "consolidated criteria for reporting qualitative research" checklist. For this analysis, we interviewed 128 anesthesiologists, asking: "Where do you see advantages in Visual Patient monitoring?" and afterward identified major and minor themes in their answers. In a second study, an online survey with 38 anesthesiologists at two different institutions, we added a quantitative part in which anesthesiologists rated statements based on the themes identified in the prior analysis on an ordinal rating scale.ResultsWe identified four high-level themes: "quick situation recognition," "intuitiveness," "unique design characteristics," and "potential future uses," and eight subthemes. The quantitative questions raised for each major theme were: 1. "The Visual Patient technology enabled me to get a quick overview of the situation." (63% of the participants agreed or very much agreed to this statement). 2. "I found the Visual Patient technology to be intuitive and easy to learn." (82% agreed or very much agreed to this statement). 3. "The visual design features of the Visual Patient technology (e.g., the avatar representation) are not helpful for patient monitoring." (11% agreed to this statement). 4. "I think the Visual Patient technology might be helpful for non-monitor experts (e.g., surgeons) in the healthcare system." (53% of the participants agreed or strongly agreed).ConclusionThis mixed method study provides evidence that the included anesthesiologists considered the new avatar-based technology to be intuitive and easy to learn and that the technology enabled them to get an overview of the situation quickly. Only a few users considered the avatar presentation to be unhelpful for patient monitoring and about half think it might be useful for non-experts.

Project description:ObjectivesThe study sought to explore the knowledge, attitudes and perceptions of healthcare providers and health programme managers regarding the benefits, challenges and impact of international medical volunteers' clinical placements. Views on how to better improve the work of international medical volunteers and the volunteer organisation Voluntary Service Overseas (VSO) for the benefit of local communities were also explored.SettingsPublic healthcare facilities, VSO offices in Gulu and VSO offices in Kampala, Uganda.ParticipantsUgandan healthcare providers (n=11) and health programme managers (n=6) who had worked with or managed international medical volunteers.InterventionsData collection was conducted using key informant interviews. Transcribed interviews were coded by topic and grouped into categories. Thematic framework analysis using NVivo identified emerging themes.ResultsBoth healthcare providers and managers reported a beneficial impact of volunteers and working with the volunteer organisation (clinical service provision, multidisciplinary teamwork, patient-centred care, implementation of audits, improved quality of care, clinical teaching and mentoring for local healthcare providers); identified challenges of working with volunteers (language barriers and unrealistic expectations) and the organisation (lack of clear communication and feedback processes); and provided recommendations to improve volunteer placements and working partnership with the organisation (more local stakeholder input and longer placements). Most healthcare providers were positive and recommended that volunteers are enabled to continue to work in such settings if resources are available to do so.ConclusionsHealthcare providers based in a low-resource setting report positive experiences and impacts of working with international medical volunteers. Currently, there is lack of local feedback processes, and the establishment of such processes that consider local stakeholder reflections requires further strengthening. These would help gain a better understanding of what is needed to ensure optimal effectiveness and sustainable impact of international medical volunteer placements.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets