Decision confidence—the subjective belief to have made the right decision—is central in planning actions in a complex environment such as the medical field. It is unclear by which factors it is influenced. We analyzed a pooled data set of eight studies and performed a multicenter online survey assessing anesthesiologists’ opinions on decision confidence. By applying mixed models and using multiple imputation to determine the effect of missing values from the dataset on the results, we investigated how task performance, perceived workload, the utilization of user-centered medical diagnostic devices, job, work experience, and gender affected decision confidence. The odds of being confident increased with better task performance (OR:1.27, 95%CI: 0.94 to 1.7; p = 0.12; after multiple imputation OR:3.19,95%CI: 2.29 to 4.45; p < 0.001) and when user-centered medical devices were used (OR:5.01, 95%CI: 3.67 to 6.85; p < 0.001; after multiple imputation OR:3.58, 95%CI: 2.65 to 4.85; p < 0.001). The odds of being confident decreased with higher perceived workload (OR: 0.94, 95%CI: 0.93 to 0.95; p < 0.001; after multiple imputation, OR:0.94, 95%CI: 0.93 to 0.95; p < 0.001). Other factors, such as gender, job, or professional experience, did not affect decision confidence. Most anesthesiologists who participated in the online survey agreed that task performance (25 of 30; 83%), perceived workload (24 of 30; 80%), work experience (28 of 30; 93%), and job (21 of 30; 70%) influence decision confidence. Improved task performance, lower perceived workload, and user-centered design in medical equipment enhanced the decision confidence of anesthesia providers.

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.

BACKGROUND Viscoelastic hemostatic assays, such as ROTEM or TEG, enable prompt diagnosis and accelerate targeted treatment. However, the complex interpretation of the results remains challenging. Visual Clot - a situation awareness-based visualization technology - was developed to assist clinicians in interpreting viscoelastic tests. OBJECTIVE Following a previous high-fidelity simulation study, we analyzed users' perceptions of the technology to identify its strengths and limitations from clinicians' perspectives. METHODS This is a mixed qualitative-quantitative study consisting of interviews and an online survey. After solving coagulation scenarios using Visual Clot in high-fidelity simulations, we interviewed anesthesia personnel about the perceived advantages and disadvantages of the new tool. We used a template approach to identify dominant themes in interview responses. Out of these themes, we then defined five main statements, which were rated on Likert scales in the online questionnaire. RESULTS We interviewed 77 participants and 23 completed the online survey. We identified nine frequently mentioned topics by analyzing interview responses. The most common themes were ``positive design features``, ``intuitive and easy to learn`` and ``lack of a quantitative component ``. In the online survey, 70% of participants agreed that Visual Clot is easy to learn and that a combination of Visual Clot and ROTEM would help manage complex hemostatic situations. CONCLUSIONS A group of anesthesia care providers found Visual Clot well-designed, intuitive and easy to learn. Participants highlighted its usefulness in emergencies, especially for clinicians inexperienced in coagulation management. However, the lack of quantitative information is an area for improvement.