JMIR Publications

ABSTRACT

Background:

Major surgery on anemic patients 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 (PBM) 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. We conducted a simulated case survey with anesthesiologists to 1) evaluate the baseline knowledge of preoperative optimization of anemia, and 2) determine the impact of real-time clinical decision support on anemia management.

Objective:

We conducted a simulated case survey with anesthesiologists to 1) evaluate the baseline knowledge of preoperative optimization of anemia, and 2) determine the impact of real-time clinical decision support on anemia management.

Methods:

We sent an electronic survey to members of the French Society of Anaesthesia and Critical Care (SFAR). The i-Anemia survey contained seven simulated case vignettes, each describing a patient’s brief clinical history and up to 3 multiple-choice questions related to preoperative anemia management (12 questions total). The cases concerned potential situations of preoperative anemia and they were created and validated with a committee of PBM 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 measure was the correct response rate.

Results:

Overall, 1.123 participants were enrolled and were randomized to Control (N=568) or Decision Support (N=555) groups. Among them, 763 participants fully responded to the survey. We obtained a complete response rate of 65.6% in the group with cognitive aid and 70.2% in the arm without assistance. The median duration of response was 10.0 (6.8) versus 7.8 (5.0) minutes respectively (p<0.001). The score significantly improved with cognitive aid (10.3±2.1) in comparison to standard care (6.2±2.1) (p<0.0001).

Conclusions:

Management strategies to optimize preoperative anaemia are not fully known and applied by anaesthesiologists in daily practice despite their clinical importance. However, adding a decision support tool can significantly improve patient care by reminding practitioners of current recommendations.