FTP1.7 Critical decision analysis of pre-hospital major haemorrhage protocol activation
British Journal of Surgery(2023)
摘要
Abstract Aims Major haemorrhage protocol activation (MHPA) facilitates immediate blood product availability and institutional capacity readiness for bleeding trauma patients. MHPA is a difficult decision pre-hospital, where two thirds of MHPAs occur. We aimed to identify the determinants and influences of the pre-hospital MHPA decision. Methods This prospective qualitative study had Health Research Authority approval (REC 22/PR/0089). Physicians from one helicopter emergency medical service (HEMS) were purposively sampled. Written informed consent was obtained. Cases representing difficult MHPA decisions within the previous six months were included. Semi-structured interviews were conducted via Microsoft Teams, following the critical decision analysis method. Interviews were transcribed and analysed using a 6-step inductive thematic analysis method on NVivo. Results Twelve interviews were conducted with nine participants: median age 37 years (range 34-45), median post-graduate experience 12 years (IQR 10.5-14.8), and median HEMS experience 1 year (IQR 0.5-4.9). Cues for (and against) the MHPA decision included: hard evidence of bleeding (or bleeding judged to be non-severe); initial information fit their mental model of a bleeding patient (or did not); patient deterioration (or response to resuscitation); acknowledgement that injuries and bleeding can be missed (or uncertainty of clinical findings); and alternative diagnoses were considered less likely (or more likely). Other influences of the MHPA decision were heuristics (especially anchoring bias), situational awareness, previous experience, colleagues on-scene, time- and task-pressure, and the desire for diagnostic accuracy and professional reputation. Conclusions Multiple determinants and influences affect the pre-hospital MHPA decision. Acknowledging these cognitive processes will inform efforts to improve decision-making in trauma.
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关键词
critical decision analysis,pre-hospital
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