JMIR Publications

ABSTRACT

Background:

Point-of-care viscoelastic coagulation testing is a time-efficient and advantageous method used in goal-directed bleeding management. To simplify the non-intuitive conventional presentation of viscoelastic test results based on abstract plots and a multitude of numbers, we have developed Visual Clot. This visualization technology applies user-centered design principles to create an animated model of the blood clot during the hemostatic cascade, illustrating the blood clot in its current state. An earlier simulation study found that Visual Clot doubled diagnostic accuracy, reduced decision-making duration, and perceived workload, and improved care provider confidence.

Objective:

This study aimed to analyze the opinions of the participants of the first Visual Clot study about the technology and to assess its strengths and limitations and its clinical applicability as a tool for coagulation management.

Methods:

We performed a researcher-initiated, international, double-center qualitative/quantitative study among the physicians who participated in the previous Visual Clot study. After a brief personal introduction to the technology and the evaluation of six coagulation scenarios with Visual Clot, we interviewed the participants asking them to tell us about the perceived pros and cons of the new tool. The identification of recurring patterns in the answers for the qualitative part of this study enabled us to formulate high-level topics and subtopics, based on which we defined six statements. The study participants rated their agreement to these statements on five-point Likert scales in an online survey, providing the quantitative part of this study.

Results:

Of the 60 physicians in the primary Visual Clot study, 36 gave an interview, and 42 completed the online survey. In the interviews, we identified the three most common themes to be "intuitive design" (mentioned by 50% of the participants), accelerating diagnostic and treatment" (50%), and "less brainwork needed" (28%). In the online survey, 92% percent of the participants agreed that they would like to have both Visual Clot and the standard result on the screen next to each other. Ninety percent of the participants agreed that Visual Clot is intuitive and easy to learn. Eighty-two percent indicated that Visual Clot might allow them to deal with complex coagulation situations more quickly.

Conclusions:

A group of anesthesia and intensive care physicians from two University hospitals in central Europe considered Visual Clot technology to be intuitive, easy to learn, and useful for decision-making in a situation of active bleeding. From the responses that these possible future users of the technology provided, Visual Clot appeared to constitute an efficient and well-accepted way to streamline the decision-making process in viscoelastic test-based coagulation management. Clinical Trial: Business Management System for Ethics Committees Number 2018-00933