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

Bioengineering (Basel). 2023 Mar 21;10(3):386. doi: 10.3390/bioengineering10030386.

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.

Keywords: coagulation management; haemostasis; point-of-care; rotational thromboelastometry; situation awareness; user-centred design; viscoelastic test.

Grants and funding

The Institute of Anaesthesiology of the University Hospital of Zurich, Zurich, Switzerland and the University of Zurich, Zurich, Switzerland funded this study.