PDF(Pubmed)
Abstract：
BACKGROUND: Major surgery on patients with anemia has demonstrated an increased risk of perioperative blood transfusions and postoperative morbidity and mortality. Recent studies have shown that integrating preoperative anemia treatment as a component of perioperative blood management may reduce blood product utilization and improve outcomes in both cardiac and noncardiac surgery. However, outpatient management of anemia falls outside of daily practice for most anesthesiologists and is probably weakly understood.
OBJECTIVE: We conducted a simulated case survey with anesthesiologists to accomplish the following aims: (1) evaluate the baseline knowledge of the preoperative optimization of anemia and (2) determine the impact of real-time clinical decision support on anemia management.
METHODS: We sent a digital survey (i-Anemia) to members of the French Society of Anaesthesia and Critical Care. The i-Anemia survey contained 7 simulated case vignettes, each describing a patient\'s brief clinical history and containing up to 3 multiple-choice questions related to preoperative anemia management (12 questions in total). The cases concerned potential situations of preoperative anemia and were created and validated with a committee of patient blood management experts. Correct answers were determined by the current guidelines or by expert consensus. Eligible participants were randomly assigned to control or decision support groups. In the decision support group, the primary outcome measured was the correct response rate.
RESULTS: Overall, 1123 participants were enrolled and randomly divided into control (n=568) and decision support (n=555) groups. Among them, 763 participants fully responded to the survey. We obtained a complete response rate of 65.6% (n=364) in the group receiving cognitive aid and 70.2% (n=399) in the group without assistance. The mean duration of response was 10.2 (SD 6.8) minutes versus 7.8 (SD 5) minutes for the decision support and control groups, respectively (P<.001). The score significantly improved with cognitive aid (mean 10.3 out of 12, SD 2.1) in comparison to standard care (mean 6.2 out of 12, SD 2.1; P<.001).
CONCLUSIONS: Management strategies to optimize preoperative anemia are not fully known and applied by anesthesiologists in daily practice despite their clinical importance. However, adding a decision support tool can significantly improve patient care by reminding practitioners of current recommendations.
OBJECTIVE: We conducted a simulated case survey with anesthesiologists to accomplish the following aims: (1) evaluate the baseline knowledge of the preoperative optimization of anemia and (2) determine the impact of real-time clinical decision support on anemia management.
METHODS: We sent a digital survey (i-Anemia) to members of the French Society of Anaesthesia and Critical Care. The i-Anemia survey contained 7 simulated case vignettes, each describing a patient\'s brief clinical history and containing up to 3 multiple-choice questions related to preoperative anemia management (12 questions in total). The cases concerned potential situations of preoperative anemia and were created and validated with a committee of patient blood management experts. Correct answers were determined by the current guidelines or by expert consensus. Eligible participants were randomly assigned to control or decision support groups. In the decision support group, the primary outcome measured was the correct response rate.
RESULTS: Overall, 1123 participants were enrolled and randomly divided into control (n=568) and decision support (n=555) groups. Among them, 763 participants fully responded to the survey. We obtained a complete response rate of 65.6% (n=364) in the group receiving cognitive aid and 70.2% (n=399) in the group without assistance. The mean duration of response was 10.2 (SD 6.8) minutes versus 7.8 (SD 5) minutes for the decision support and control groups, respectively (P<.001). The score significantly improved with cognitive aid (mean 10.3 out of 12, SD 2.1) in comparison to standard care (mean 6.2 out of 12, SD 2.1; P<.001).
CONCLUSIONS: Management strategies to optimize preoperative anemia are not fully known and applied by anesthesiologists in daily practice despite their clinical importance. However, adding a decision support tool can significantly improve patient care by reminding practitioners of current recommendations.
摘要：
背景：对贫血患者进行大手术已证明围手术期输血的风险增加，以及术后的发病率和死亡率增加。最近的研究表明，将术前贫血治疗作为围手术期血液管理的组成部分，可能会降低血液制品的利用率并改善心脏和非心脏手术的预后。然而,对于大多数麻醉师来说,贫血的门诊管理不属于日常工作,可能对其了解不足.
目的：我们与麻醉医师进行了一项模拟病例调查，以达到以下目的：（1）评估贫血术前优化的基线知识；（2）确定实时临床决策支持对贫血管理的影响。
方法：我们向法国麻醉和重症监护协会的成员发送了一项数字调查（i-anemia）。i-贫血调查包含7个模拟病例小插曲，每个描述患者的简短临床病史,并包含多达3个与术前贫血管理相关的多项选择题(共12个问题).这些病例涉及术前贫血的潜在情况，并由患者血液管理专家委员会创建和验证。正确答案由当前指南或专家共识确定。符合条件的参与者被随机分配到对照组或决策支持组。在决策支持小组中，测量的主要结局是正确的缓解率.
结果：总体而言，1123名参与者被随机分为对照组（n=568）和决策支持组（n=555）。其中,763名参与者完全回答了调查。在接受认知援助的组中，我们获得了65.6％（n=364）的完全缓解率，在没有帮助的组中获得了70.2％（n=399）的完全缓解率。决策支持组和对照组的平均反应持续时间为10.2（SD6.8）分钟与7.8（SD5）分钟，分别(P<.001)。与标准护理（12个中的平均6.2个，SD2.1；P<.001）相比，认知辅助评分显着提高（12个中的平均10.3个，SD2.1个）。
结论：优化术前贫血的管理策略虽然具有临床重要性，但麻醉医师在日常实践中并未完全了解和应用。然而,增加决策支持工具可以通过提醒从业者当前的建议来显著改善患者护理.
目的：我们与麻醉医师进行了一项模拟病例调查，以达到以下目的：（1）评估贫血术前优化的基线知识；（2）确定实时临床决策支持对贫血管理的影响。
方法：我们向法国麻醉和重症监护协会的成员发送了一项数字调查（i-anemia）。i-贫血调查包含7个模拟病例小插曲，每个描述患者的简短临床病史,并包含多达3个与术前贫血管理相关的多项选择题(共12个问题).这些病例涉及术前贫血的潜在情况，并由患者血液管理专家委员会创建和验证。正确答案由当前指南或专家共识确定。符合条件的参与者被随机分配到对照组或决策支持组。在决策支持小组中，测量的主要结局是正确的缓解率.
结果：总体而言，1123名参与者被随机分为对照组（n=568）和决策支持组（n=555）。其中,763名参与者完全回答了调查。在接受认知援助的组中，我们获得了65.6％（n=364）的完全缓解率，在没有帮助的组中获得了70.2％（n=399）的完全缓解率。决策支持组和对照组的平均反应持续时间为10.2（SD6.8）分钟与7.8（SD5）分钟，分别(P<.001)。与标准护理（12个中的平均6.2个，SD2.1；P<.001）相比，认知辅助评分显着提高（12个中的平均10.3个，SD2.1个）。
结论：优化术前贫血的管理策略虽然具有临床重要性，但麻醉医师在日常实践中并未完全了解和应用。然而,增加决策支持工具可以通过提醒从业者当前的建议来显著改善患者护理.
