• Lisa-Marie Buchner, Eun Ji Park, Pamela Bendz, Anne Englert, Cornelius von der Groeben, Linda Vo, Elke Schmitt, Kai Zacharowski, Philipp Börm, Dominik Stauber, Tobias Bingold, Michael Booke, Mathias Gerth, Clemens-Alexander Greim, Jan Mersmann, Ralf Michael Muellenbach, Haitham Mutlak, Bernhard Ott, Andreas Pape, Michael Sander, Rolf Teßmann, Martin Welte, Julius Wermelt, Hinnerk Wulf, Suma Choorapoikayil, Christoph Füllenbach, and Patrick Meybohm.
• Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.
• J Clin Anesth. 2022 Sep 1; 80: 110877.

Study ObjectiveWe explored the feasibility of a Clinical Decision Support System (CDSS) to guide evidence-based perioperative anticoagulation.DesignProspective randomised clinical management simulation multicentre study.SettingFive University and 11 general hospitals in Germany.ParticipantsWe enrolled physicians (anaesthesiologist (n = 73), trauma surgeons (n = 2), unknown (n = 1)) with different professional experience.InterventionsA CDSS based on a multiple-choice test was developed and validated at the University Hospital of Frankfurt (phase-I). The CDSS comprised European guidelines for the management of anticoagulation in cardiology, cardio-thoracic, non-cardio-thoracic surgery and anaesthesiology. Phase-II compared the efficiency of physicians in identifying evidence-based approach of managing perioperative anticoagulation. In total 168 physicians were randomised to CDSS (PERI-KOAG) or CONTROL.MeasurementsOverall mean score and association of processing time and professional experience were analysed. The multiple-choice test consists of 11 cases and two correct answers per question were required to gain 100% success rate (=22 points).Main ResultsIn total 76 physicians completed the questionnaire (n = 42 PERI-KOAG; n = 34 CONTROL; attrition rate 54%). Overall mean score (max. 100% = 22 points) was significantly higher in PERI-KOAG compared to CONTROL (82 ± 15% vs. 70 ± 10%; 18 ± 3 vs. 15 ± 2 points; P = 0.0003). A longer processing time is associated with significantly increased overall mean scores in PERI-KOAG (≥33 min. 89 ± 10% (20 ± 2 points) vs. <33 min. 73 ± 15% (16 ± 3 points), P = 0.0005) but not in CONTROL (≥33 min. 74 ± 13% (16 ± 3 points) vs. <33 min. 69 ± 9% (15 ± 2 points), P = 0.11). Within PERI-KOAG, there is a tendency towards higher results within the more experienced group (>5 years), but no significant difference to less (≤5 years) experienced colleagues (87 ± 10% (19 ± 2 points) vs. 78 ± 17% (17 ± 4 points), P = 0.08). However, an association between professional experience and success rate in CONTROL has not been shown (71 ± 8% vs. 70 ± 13%, 16 ± 2 vs. 15 ± 3 points; P = 0.66).ConclusionsCDSS significantly improved the identification of evidence-based treatment approaches. A precise usage of CDSS is mandatory to maximise efficiency.Copyright © 2022 Elsevier Inc. All rights reserved.

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