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Evaluation of a Clinical Decision Support System for the most evidence-based approach to managing perioperative anticoagulation |
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| Institution: | 1. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany;2. Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany;3. Börm Bruckmeier Verlag GmbH, Munich, Germany;4. Department of Anaesthesiology, Helios Dr. Horst Schmidt Hospital Wiesbaden, Wiesbaden, Germany;5. Department of Anaesthesiology, Hospital Bad Soden, Bad Soden, Germany;6. Department of Anaesthesiology, University Hospital Mainz, Mainz, Germany;7. Department of Anaesthesiology, Hospital Fulda, Fulda, Germany;8. Department of Anaesthesiology, Hochtaunus Hospital Bad Homburg, Bad Homburg, Germany;9. Department of Anaesthesiology, Hospital Kassel, Kassel, Germany;10. Department of Anaesthesiology, Sanaklinikum Offenbach, Offenbach, Germany;11. Department of Anaesthesiology, BG Unfallklinik Murnau, Murnau, Germany;12. Department of Anaesthesiology, Sankt Katharinen Hospital Frankfurt, Frankfurt, Germany;13. Department of Anaesthesiology, University Hospital Gießen, Germany;14. Department of Anaesthesiology, BG Unfallklinik Frankfurt, Frankfurt, Germany;15. Department of Anaesthesiology, Hospital Darmstadt, Darmstadt, Germany;p. Department of Anaesthesiology, Bürgerhospital Frankfurt, Frankfurt, Germany;q. Department of Anaesthesiology, University Hospital Marburg, Marburg, Germany;1. Department of Anaesthesiology, Shanghai Jiaotong University Affiliated Sixth People''s Hospital, 600 Yishan Road, Shanghai, China;2. Department of Critical Care, Shanghai Jiaotong University Affiliated Sixth People''s Hospital, 600 Yishan Road, Shanghai, China;1. Department of Anesthesiology, Qingdao Women''s and Children''s Hospital Affiliated to Qingdao University, Qingdao 266000, People''s Republic of China;2. Department of Anesthesiology, The Affiliated Hospital of Qingdao University Medical College, Qingdao 266000, People''s Republic of China;1. Department of Anesthesiology, Guangdong Provincial People''s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China;2. Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China;3. Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, China |
| Abstract: | Study objectiveWe explored the feasibility of a Clinical Decision Support System (CDSS) to guide evidence-based perioperative anticoagulation.DesignProspective randomised clinical management simulation multicentre study.SettingFive University and 11 general hospitals in Germany.ParticipantsWe enrolled physicians (anaesthesiologist (n = 73), trauma surgeons (n = 2), unknown (n = 1)) with different professional experience.InterventionsA CDSS based on a multiple-choice test was developed and validated at the University Hospital of Frankfurt (phase-I). The CDSS comprised European guidelines for the management of anticoagulation in cardiology, cardio-thoracic, non-cardio-thoracic surgery and anaesthesiology. Phase-II compared the efficiency of physicians in identifying evidence-based approach of managing perioperative anticoagulation. In total 168 physicians were randomised to CDSS (PERI-KOAG) or CONTROL.MeasurementsOverall mean score and association of processing time and professional experience were analysed. The multiple-choice test consists of 11 cases and two correct answers per question were required to gain 100% success rate (=22 points).Main resultsIn total 76 physicians completed the questionnaire (n = 42 PERI-KOAG; n = 34 CONTROL; attrition rate 54%). Overall mean score (max. 100% = 22 points) was significantly higher in PERI-KOAG compared to CONTROL (82 ± 15% vs. 70 ± 10%; 18 ± 3 vs. 15 ± 2 points; P = 0.0003). A longer processing time is associated with significantly increased overall mean scores in PERI-KOAG (≥33 min. 89 ± 10% (20 ± 2 points) vs. <33 min. 73 ± 15% (16 ± 3 points), P = 0.0005) but not in CONTROL (≥33 min. 74 ± 13% (16 ± 3 points) vs. <33 min. 69 ± 9% (15 ± 2 points), P = 0.11). Within PERI-KOAG, there is a tendency towards higher results within the more experienced group (>5 years), but no significant difference to less (≤5 years) experienced colleagues (87 ± 10% (19 ± 2 points) vs. 78 ± 17% (17 ± 4 points), P = 0.08). However, an association between professional experience and success rate in CONTROL has not been shown (71 ± 8% vs. 70 ± 13%, 16 ± 2 vs. 15 ± 3 points; P = 0.66).ConclusionsCDSS significantly improved the identification of evidence-based treatment approaches. A precise usage of CDSS is mandatory to maximise efficiency. |
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