User Perceptions of ROTEM-Guided Haemostatic Resuscitation: A Mixed Qualitative–Quantitative Study

Abstract

Viscoelastic point-of-care haemostatic resuscitation methods, such as ROTEM or TEG, are crucial in deciding on time-efficient personalised coagulation interventions. International transfusion guidelines emphasise increased patient safety and reduced treatment costs. We analysed care providers’ perceptions of ROTEM to identify perceived strengths and areas for improvement. We conducted a single-centre, mixed qualitative–quantitative study consisting of interviews followed by an online survey. Using a template approach, we first identified themes in the responses given by care providers about ROTEM. Later, the participants rated six statements based on the identified themes on five-point Likert scales in an online questionnaire. Seventy-seven participants were interviewed, and 52 completed the online survey. By analysing user perceptions, we identified ten themes. The most common positive theme was “high accuracy”. The most common negative theme was “need for training”. In the online survey, 94% of participants agreed that monitoring the real-time ROTEM temograms helps to initiate targeted treatment more quickly and 81% agreed that recurrent ROTEM training would be beneficial. Anaesthesia care providers found ROTEM to be accurate and quickly available to support decision-making in dynamic and complex haemostatic situations. However, clinicians identified that interpreting ROTEM is a complex and cognitively demanding task that requires significant training needs.

Human-centered visualization technologies for patient monitoring are the future: a narrative review

“…Interpreting rotational thromboelastometry (ROTEM) results is a complex and cognitively demanding task that requires significant training [67,68]. Visual Clot is a visual representation of viscoelastic test results under development by our research group (Fig.…”

Treatment of Intracranial Hemorrhagic Lesions Associated With Jacobsen’s Syndrome

“…In addition to common blood cell tests (platelet counts, prothrombin time, activated partial thromboplastin clotting time (aPTT)), other numerical visualizations of coagulation abnormalities include thromboelastography (TEG) and thromboelastometry (ROTEM) [ 6 ], measurement of von Willebrand factor (VWF) and Factor 13, and platelet aggregation capacity [ 7 ]. In this case, blood viscoelasticity was almost normal, vWFs were normal, factor 13 antigen and activity were mildly decreased, and platelet aggregation capacity was not performed because it is a research-based measurement.…”

User Perceptions of Visual Clot in a High-Fidelity Simulation Study: Mixed Qualitative-Quantitative Study

“…Secondary outcomes were time to targeted coagulation therapy, confidence, and workload. ROTEM is the standard of care for managing acute hemorrhage in the study center, so all participants were familiar with the technology before participating [20]. Some participants had taken part in previous Visual Clot studies and, therefore, were already familiar with the technology [22,24].…”

“…Previous Visual Clot studies [22][23][24]36,37] underline the benefits of additional visualization technology, simplifying standard ROTEM data interpretation [20]. Anesthesia providers using Visual Clot in a high-fidelity simulation study were more likely to correctly administer targeted coagulation therapy and to give the first targeted coagulation product faster.…”

“…Viscoelastic hemostatic tests are also paramount in the diagnostic and treatment adjustment of hematological disorders, such as inherited afibrinogenemia, hemophilia, or multiple myeloma [15][16][17][18]. However, despite these technologies' widespread use and considerable advantages, their results' interpretation remains challenging and requires well-trained clinical personnel [19][20][21]. Visual Clot-a situation awareness-based visualization technology-was developed to support health care professionals in interpreting viscoelastic test results by reducing the complexity of their presentation.…”