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Nabecker S, Nation K, Gilfoyle E, Abelairas-Gomez C, Koota E, Lin Y, Greif R. Cognitive aids used in simulated resuscitation: A systematic review. Resusc Plus 2024; 19:100675. [PMID: 38873274 PMCID: PMC11170275 DOI: 10.1016/j.resplu.2024.100675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
Objectives To compare the effectiveness of cognitive aid use during resuscitation with no use of cognitive aids on cardiopulmonary resuscitation quality and performance. Methods This systematic review followed the PICOST format. All randomised controlled trials and non-randomised studies evaluating cognitive aid use during (simulated) resuscitation were included in any setting. Unpublished studies were excluded. We did not include studies that reported cognitive aid use during training for resuscitation alone. Medline, Embase and Cochrane databases were searched from inception until July 2019 (updated August 2022, November 2023, and 23 April 2024). We did not search trial registries. Title and abstract screening, full-text screening, data extraction, risk of bias assessment (using RoB2 and ROBINS-I), and certainty of evidence (using GRADE) were performed by two researchers. PRISMA reporting standards were followed, and registration (PROSPERO CRD42020159162, version 19 July 2022) was performed. No funding has been obtained. Results The literature search identified 5029 citations. After removing 512 duplicates, reviewing the titles and abstracts of the remaining articles yielded 103 articles for full-text review. Hand-searching identified 3 more studies for full-text review. Of these, 29 studies were included in the final analysis. No clinical studies involving patients were identified. The review was limited to indirect evidence from simulation studies only. The results are presented in five different populations: healthcare professionals managing simulated resuscitations in neonates, children, adult advanced life support, and other emergencies; as well as lay providers managing resuscitations. Main outcomes were adherence to protocol or process, adherence to protocol or process assessed by performance score, CPR performance and retention, and feasibility of chatbot guidance. The risk of bias assessment ranged from low to high. Studies in neonatal, paediatric and adult life support delivered by healthcare professionals showed benefits of using cognitive aids, however, some studies evaluating resuscitations by lay providers reported undesirable effects. The performance of a meta-analysis was not possible due to significant methodological heterogeneity. The certainty of evidence was rated as moderate to very low due to serious indirectness, (very) serious risk of bias, serious inconsistency and (very) serious imprecision. Conclusion Because of the very low certainty evidence from simulation studies, we suggest that cognitive aids should be used by healthcare professionals during resuscitation. In contrast, we do not suggest use of cognitive aids for lay providers, based on low certainty evidence.
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Affiliation(s)
- Sabine Nabecker
- Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada
| | - Kevin Nation
- New Zealand Resuscitation Council, Wellington, New Zealand
| | - Elaine Gilfoyle
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Cristian Abelairas-Gomez
- Faculty of Education Sciences and CLINURSID Research Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
| | - Elina Koota
- HUS Joint Resources, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Yiqun Lin
- KidSIM Simulation Education and Research Program, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Robert Greif
- University of Bern, Bern, Switzerland
- Department of Surgical Science, University of Torino, Torino, Italy
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Grundgeiger T, Michalek A, Hahn F, Wurmb T, Meybohm P, Happel O. Guiding Attention via a Cognitive Aid During a Simulated In-Hospital Cardiac Arrest Scenario: A Salience Effort Expectancy Value Model Analysis. HUMAN FACTORS 2023; 65:1689-1701. [PMID: 34957862 DOI: 10.1177/00187208211060586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effect of a cognitive aid on the visual attention distribution of the operator using the Salience Effort Expectancy Value (SEEV) model. BACKGROUND Cognitive aids aim to support an operator during the execution of a task. The effect of cognitive aids on performance is frequently evaluated but whether a cognitive aid improved, for example, attention distribution has not been considered. METHOD We built the Expectancy Value (EV) model version which can be considered to indicate optimal attention distribution for a given event. We analyzed the eye tracking data of emergency physicians while using a cognitive aid application versus no application during a simulated in-hospital cardiac arrest scenario. RESULTS The EV model could fit the attention distribution in such a simulated emergency situation. Partially supporting our hypothesis, the cognitive aid application group showed a significantly better EV model fit than the no application group in the first phases of the event, but a worse fit in the last phase. CONCLUSION We demonstrated that a cognitive aid affected attention distribution and that the SEEV model provides the means of capturing these effects. We suggest that the aid supported and improved visual attention distribution in the stressful first phases of a cardiopulmonary resuscitation but may have focused attention on objects that are relevant for lower priority goals in the last phase. APPLICATION The SEEV model can provide insights into expected and unexpected effects of cognitive aids on visual attention distribution and may help to design better artifacts.
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Affiliation(s)
- Tobias Grundgeiger
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Annabell Michalek
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
| | - Felix Hahn
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Thomas Wurmb
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Oliver Happel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
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Tsang KD, Ottow MK, van Heijst AFJ, Antonius TAJ. Electronic Decision Support in the Delivery Room Using Augmented Reality to Improve Newborn Life Support Guideline Adherence: A Randomized Controlled Pilot Study. Simul Healthc 2022; 17:293-298. [PMID: 35102128 PMCID: PMC9553249 DOI: 10.1097/sih.0000000000000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Newborn Life Support (NLS) guideline aims to provide healthcare professionals a consistent approach during neonatal resuscitation. Adherence to this and analogous guidelines has repetitively been proven to be difficult.This study evaluates adherence to guideline using a novel augmented reality (Microsoft HoloLens) electronic decision support tool during standardized simulated neonatal resuscitation compared with subjects working from memory alone. METHODS In this randomized controlled pilot study, 18 professionals responsible for neonatal resuscitation were randomized to the intervention group and 11 to the control group. Demographic characteristics were similar between both groups. A standardized neonatal resuscitation scenario was performed, which was recorded and later assessed for adherence to the NLS algorithm by 2 independent reviewers. Secondary outcomes were error classification in case of algorithm deviation and time to the execution or completion of critical steps in the algorithm to determine delay. RESULTS Median (interquartile range) scores of a theoretical maximum of 40 in the intervention group were 34 (32.5-35.5) versus 29 (27-33) in the control group ( P = 0.004). Errors of commission were committed less frequently with the electronic decision support tool 2 (1-2.5) compared with 4 (2-4) in the control group ( P = 0.029). Analysis of time to initiation or completion of key steps in the NLS algorithm showed no significant differences between both groups. CONCLUSIONS Healthcare professionals using an electronic decision support tool showed improved adherence to the NLS guideline during simulated neonatal resuscitation.
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Corazza F, Fiorese E, Arpone M, Tardini G, Frigo AC, Cheng A, Da Dalt L, Bressan S. The impact of cognitive aids on resuscitation performance in in-hospital cardiac arrest scenarios: a systematic review and meta-analysis. Intern Emerg Med 2022; 17:2143-2158. [PMID: 36031672 PMCID: PMC9420676 DOI: 10.1007/s11739-022-03041-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
Different cognitive aids have been recently developed to support the management of cardiac arrest, however, their effectiveness remains barely investigated. We aimed to assess whether clinicians using any cognitive aids compared to no or alternative cognitive aids for in-hospital cardiac arrest (IHCA) scenarios achieve improved resuscitation performance. PubMed, EMBASE, the Cochrane Library, CINAHL and ClinicalTrials.gov were systematically searched to identify studies comparing the management of adult/paediatric IHCA simulated scenarios by health professionals using different or no cognitive aids. Our primary outcomes were adherence to guideline recommendations (overall team performance) and time to critical resuscitation actions. Random-effects model meta-analyses were performed. Of the 4.830 screened studies, 16 (14 adult, 2 paediatric) met inclusion criteria. Meta-analyses of eight eligible adult studies indicated that the use of electronic/paper-based cognitive aids, in comparison with no aid, was significantly associated with better overall resuscitation performance [standard mean difference (SMD) 1.16; 95% confidence interval (CI) 0.64; 1.69; I2 = 79%]. Meta-analyses of the two paediatric studies, showed non-significant improvement of critical actions for resuscitation (adherence to guideline recommended sequence of actions, time to defibrillation, rate of errors in defibrillation, time to start chest compressions), except for significant shorter time to amiodarone administration (SMD - 0.78; 95% CI - 1.39; - 0.18; I2 = 0). To conclude, the use of cognitive aids appears to have benefits in improving the management of simulated adult IHCA scenarios, with potential positive impact on clinical practice. Further paediatric studies are necessary to better assess the impact of cognitive aids on the management of IHCA scenarios.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
| | - Elena Fiorese
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Giacomo Tardini
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Adam Cheng
- Departments of Paediatrics and Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Canada
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, University Hospital of Padova, Padova, Italy.
- Department of Women's and Children's Health, University of Padova, Padova, Italy.
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Grundgeiger T, Hahn F, Wurmb T, Meybohm P, Happel O. The use of a cognitive aid app supports guideline-conforming cardiopulmonary resuscitations: A randomized study in a high-fidelity simulation. Resusc Plus 2021; 7:100152. [PMID: 34458879 PMCID: PMC8379507 DOI: 10.1016/j.resplu.2021.100152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022] Open
Abstract
Aim Cardiac arrests require fast, well-timed, and well-coordinated interventions delivered by several staff members. We evaluated a cognitive aid that works as an attentional aid to support specifically the timing and coordination of these interventions. We report the results of an experimental, simulation-based evaluation of the tablet-based cognitive aid in performing guideline-conforming cardiopulmonary resuscitation. Methods In a parallel group design, emergency teams (one qualified emergency physician as team leader and one qualified nurse) were randomly assigned to the cognitive aid application (CA App) group or the no application (No App) group and then participated in a simulated scenario of a cardiac arrest. The primary outcome was a cardiopulmonary resuscitation performance score ranging from zero to two for each team based on the videotaped scenarios in relation to twelve performance variables derived from the European Resuscitation Guidelines. As a secondary outcome, we measured the participants’ subjective workload. Results A total of 67 teams participated. The CA App group (n = 32 teams) showed significantly better cardiopulmonary resuscitation performance than the No App group (n = 31 teams; mean difference = 0.23, 95 %CI = 0.08 to 0.38, p = 0.002, d = 0.83). The CA App group team leaders indicated significantly less mental and physical demand and less effort to achieve their performance compared to the No App group team leaders. Conclusions Among well-trained in-hospital emergency teams, the cognitive aid could improve cardiopulmonary resuscitation coordination performance and decrease mental workload.
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Affiliation(s)
- T Grundgeiger
- Institute Human-Computer-Media, Julius-Maximilians-Universität Würzburg, Oswald-Külpe-Weg 82, 97074 Würzburg, Germany
| | - F Hahn
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - T Wurmb
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - P Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - O Happel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital of Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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Tablet-Based Decision Support Tool Improves Performance of Neonatal Resuscitation: A Randomized Trial in Simulation. Simul Healthc 2021; 15:243-250. [PMID: 32168290 DOI: 10.1097/sih.0000000000000422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Decision support tools (DST) may aid compliance of teams with the Neonatal Resuscitation Program (NRP) algorithm but have not been adequately tested in this population. Furthermore, the optimal team size for neonatal resuscitation is not known. Our aim was to determine whether use of a tablet-based DST or team size altered adherence to the NRP algorithm in teams of healthcare providers (HCPs) performing simulated neonatal resuscitation. METHOD One hundred nine HCPs were randomized into a team of 2 or 3 and into using a DST or memory alone while performing 2 simulation scenarios. The primary outcome was NRP compliance, assessed by the modified Neonatal Resuscitation Performance Evaluation (NRPE). Secondary outcomes were the subcomponents of the NRPE score, cumulative time error (the cumulative time in seconds to perform resuscitation tasks in error, early or late, from NRP guidelines), and the interaction between DST and team size. RESULTS Decision support tool use improved total NRPE score when compared with memory alone (p = 0.015). There was no difference in NRPE score within teams of 2 compared with 3 HCPs. Cumulative time error was decreased with DST use compared with memory alone but was not significant (p = 0.057). Team size did not affect time error. CONCLUSIONS Teams with the DST had improved NRP adherence compared with teams relying on memory alone in 1 of 2 scenarios. Two and 3 HCP teams performed similarly. Given the positive results observed in the simulated environment, further testing the DST in the clinical environment is warranted.
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Corazza F, Arpone M, Snijders D, Cheng A, Stritoni V, Ingrassia PL, De Luca M, Tortorolo L, Frigo AC, Da Dalt L, Bressan S. PediAppRREST: effectiveness of an interactive cognitive support tablet app in reducing deviations from guidelines in the management of paediatric cardiac arrest: protocol for a simulation-based randomised controlled trial. BMJ Open 2021; 11:e047208. [PMID: 34321297 PMCID: PMC8319988 DOI: 10.1136/bmjopen-2020-047208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 07/01/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Paediatric cardiac arrest (PCA), despite its low incidence, has a high mortality. Its management is complex and deviations from guideline recommendations occur frequently. We developed a new interactive tablet app, named PediAppRREST, to support the management of PCA. The app received a good usability evaluation in a previous pilot trial. The aim of the study is to evaluate the effectiveness of the PediAppRREST app in reducing deviations from guideline recommendations in PCA management. METHODS AND ANALYSIS This is a multicentre, simulation-based, randomised controlled, three-parallel-arm study. Participants are residents in Paediatric, Emergency Medicine, and Anaesthesiology programmes in Italy. All 105 teams (315 participants) manage the same scenario of in-hospital PCA. Teams are randomised by the study statistician into one of three study arms for the management of the PCA scenario: (1) an intervention group using the PediAppRREST app or (2) a control group Paediatric Advanced Life Support (CtrlPALS+) using the PALS pocket reference card; or (3) a control group (CtrlPALS-) not allowed to use any PALS-related cognitive aid. The primary outcome of the study is the number of deviations (delays and errors) in PCA management from PALS guideline recommendations, according to a novel checklist, named c-DEV15plus. The c-DEV15plus scores will be compared between groups with a one-way analysis of variance model, followed by the Tukey-Kramer multiple comparisons adjustment procedure in case of statistical significance. ETHICS AND DISSEMINATION The Ethics Committee of the University Hospital of Padova, coordinating centre of the trial, deemed the project to be a negligible risk study and approved it through an expedited review process. The results of the study will be disseminated in peer-reviewed journals, and at national and international scientific conferences. Based on the study results, the PediAppRREST app will be further refined and will be available for download by institutions/healthcare professionals. TRIAL REGISTRATION NUMBER NCT04619498; Pre-results.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Adam Cheng
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Pier Luigi Ingrassia
- Interdepartmental Centre for Innovative Didactics and Simulation in Medicine and Health Professions, SIMNOVA, University of Eastern Piedmont Amedeo Avogadro School of Medicine, Novara, Italy
| | - Marco De Luca
- Pediatric Emergency Medicine, Meyer University Hospital, University of Florence, Florence, Italy
| | - Luca Tortorolo
- Institute of Intensive Care Medicine and Anesthesiology, Agostino Gemelli University Hospital, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Rome, Italy
| | - Anna Chiara Frigo
- Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padua, Padua, Italy
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Huynh TK, Schoonover A, Harrod T, Bahr N, Guise JM. Characterizing prehospital response to neonatal resuscitation. Resusc Plus 2021; 5:100086. [PMID: 34223352 PMCID: PMC8244404 DOI: 10.1016/j.resplu.2021.100086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate performance of initial steps of newborn resuscitation according to the American Heart Association and American Academy of Pediatrics' Neonatal Resuscitation Program (NRP) guidelines in the prehospital setting. Study Design Observational study of 265 paramedics and Emergency Medical Technicians (EMTs) from 45 EMS teams recruited from public fire and private transport agencies in a major metropolitan area. Participants completed a baseline questionnaire assessing demographics, experience, and comfort in caring for children. Simulations were conducted April 2015 to March 2016. Technical performance was evaluated by blinded video review. NRP actions were assessed using a structured performance tool. Results Two hundred sixty-five EMS providers responded to survey questions and participated in simulations. In total, 16% reported feeling very or extremely comfortable caring for children <30 days of age (vs. 71% for children aged 12-18 years). Among 45 EMS teams participating in simulations, 22% (n = 10) dried, 18% (n = 8) stimulated, and 2% (n = 1) warmed within 30 s from arrival and 11% (n = 5) provided BMV within 60 s from arrival, as recommended by NRP. All teams provided BMV. Eighty-eight percent bagged below NRP rate recommendations and 96% bagged with tidal volume exceeding guidelines. Looking over the entire 10-min simulation for ever performing measures, 73% started to dry the baby within a median of 51 (range 0-539) seconds from arrival, 38% started to stimulate the baby within a median of 34 s (range 0-181), and 44% started to warm the baby within a median 291 s (range 27-575 s). Conclusions These data from field simulations suggest NRP steps recommended for the first minute after birth are seldom performed in a timely manner and suggests opportunities for improvement.
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Affiliation(s)
- Trang Kieu Huynh
- Department of Pediatrics, Oregon Health and Science University, United States
| | - Amanda Schoonover
- Department of Obstetrics and Gynecology, Oregon Health and Science University, United States
| | - Tabria Harrod
- Department of Obstetrics and Gynecology, Oregon Health and Science University, United States
| | - Nathan Bahr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, United States
| | - Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Oregon Health and Science University, United States
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Corazza F, Snijders D, Arpone M, Stritoni V, Martinolli F, Daverio M, Losi MG, Soldi L, Tesauri F, Da Dalt L, Bressan S. Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study. JMIR Mhealth Uhealth 2020; 8:e19070. [PMID: 32788142 PMCID: PMC7563631 DOI: 10.2196/19070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 01/22/2023] Open
Abstract
Background Pediatric cardiac arrest (PCA), although rare, is associated with high mortality. Deviations from international management guidelines are frequent and associated with poorer outcomes. Different strategies/devices have been developed to improve the management of cardiac arrest, including cognitive aids. However, there is very limited experience on the usefulness of interactive cognitive aids in the format of an app in PCA. No app has so far been tested for its usability and effectiveness in guiding the management of PCA. Objective To develop a new audiovisual interactive app for tablets, named PediAppRREST, to support the management of PCA and to test its usability in a high-fidelity simulation-based setting. Methods A research team at the University of Padova (Italy) and human–machine interface designers, as well as app developers, from an Italian company (RE:Lab S.r.l.) developed the app between March and October 2019, by applying an iterative design approach (ie, design–prototyping–evaluation iterative loops). In October–November 2019, a single-center nonrandomized controlled simulation–based pilot study was conducted including 48 pediatric residents divided into teams of 3. The same nonshockable PCA scenario was managed by 11 teams with and 5 without the app. The app user’s experience and interaction patterns were documented through video recording of scenarios, debriefing sessions, and questionnaires. App usability was evaluated with the User Experience Questionnaire (UEQ) (scores range from –3 to +3 for each scale) and open-ended questions, whereas participants’ workload was measured using the NASA Raw-Task Load Index (NASA RTLX). Results Users’ difficulties in interacting with the app during the simulations were identified using a structured framework. The app usability, in terms of mean UEQ scores, was as follows: attractiveness 1.71 (SD 1.43), perspicuity 1.75 (SD 0.88), efficiency 1.93 (SD 0.93), dependability 1.57 (SD 1.10), stimulation 1.60 (SD 1.33), and novelty 2.21 (SD 0.74). Team leaders’ perceived workload was comparable (P=.57) between the 2 groups; median NASA RTLX score was 67.5 (interquartile range [IQR] 65.0-81.7) for the control group and 66.7 (IQR 54.2-76.7) for the intervention group. A preliminary evaluation of the effectiveness of the app in reducing deviations from guidelines showed that median time to epinephrine administration was significantly longer in the group that used the app compared with the control group (254 seconds versus 165 seconds; P=.015). Conclusions The PediAppRREST app received a good usability evaluation and did not appear to increase team leaders’ workload. Based on the feedback collected from the participants and the preliminary results of the evaluation of its effects on the management of the simulated scenario, the app has been further refined. The effectiveness of the new version of the app in reducing deviations from guidelines recommendations in the management of PCA and its impact on time to critical actions will be evaluated in an upcoming multicenter simulation-based randomized controlled trial.
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Affiliation(s)
- Francesco Corazza
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Deborah Snijders
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marta Arpone
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Valentina Stritoni
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Francesco Martinolli
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Marco Daverio
- Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | | | | | | | - Liviana Da Dalt
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Silvia Bressan
- Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Abstract
OBJECTIVE This study aimed to organize the literature on cognitive aids to allow comparison of findings across studies and link the applied work of aid development to psychological constructs and theories of cognition. BACKGROUND Numerous taxonomies have been developed, all of which label cognitive aids via their surface characteristics. This complicates integration of the literature, as a type of aid, such as a checklist, can provide many different forms of support (cf. prospective memory for steps and decision support for alternative diagnoses). METHOD In this synthesis of the literature, we address the disparate findings and organize them at their most basic level: Which cognitive processes does the aid need to support? Which processes do they support? Such processes include attention, perception, decision making, memory, and declarative knowledge. RESULTS Cognitive aids can be classified into the processes they support. Some studies focused on how an aid supports the cognitive processes demanded by the task (aid function). Other studies focused on supporting the processes needed to utilize the aid (aid usability). CONCLUSION Classifying cognitive aids according to the processes they support allows comparison across studies in the literature and a formalized way of planning the design of new cognitive aids. Once the literature is organized, theory-based guidelines and applied examples can be used by cognitive aid researchers and designers. APPLICATION Aids can be designed according to the cognitive processes they need to support. Designers can be clear about their focus, either examining how to support specific cognitive processes or improving the usability of the aid.
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Siebert JN, Lacroix L, Cantais A, Manzano S, Ehrler F. The Impact of a Tablet App on Adherence to American Heart Association Guidelines During Simulated Pediatric Cardiopulmonary Resuscitation: Randomized Controlled Trial. J Med Internet Res 2020; 22:e17792. [PMID: 32292179 PMCID: PMC7287744 DOI: 10.2196/17792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Evidence-based best practices are the cornerstone to guide optimal cardiopulmonary arrest resuscitation care. Adherence to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite advances in resuscitation science and survival improvement over the last decades, only approximately 38% of children survive to hospital discharge after in-hospital cardiac arrest and only 6%-20% after out-of-hospital cardiac arrest. Objective We investigated whether a mobile app developed as a guide to support and drive CPR providers in real time through interactive pediatric advanced life support (PALS) algorithms would increase adherence to AHA guidelines and reduce the time to initiation of critical life-saving maneuvers compared to the use of PALS pocket reference cards. Methods This study was a randomized controlled trial conducted during a simulation-based pediatric cardiac arrest scenario caused by pulseless ventricular tachycardia (pVT). A total of 26 pediatric residents were randomized into two groups. The primary outcome was the elapsed time in seconds in each allocation group from the onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, including the time intervals between defibrillation attempts and drug doses, shock doses, and the number of shocks. All outcomes were assessed for deviation from AHA guidelines. Results Mean time to the first defibrillation attempt (121.4 sec, 95% CI 105.3-137.5) was significantly reduced among residents using the app compared to those using PALS pocket cards (211.5 sec, 95% CI 162.5-260.6, P<.001). With the app, 11 out of 13 (85%) residents initiated chest compressions within 60 seconds from the onset of pVT and 12 out of 13 (92%) successfully defibrillated within 180 seconds. Time to all other defibrillation attempts was reduced with the app. Adherence to the 2018 AHA pVT algorithm improved by approximately 70% (P=.001) when using the app following all CPR sequences of action in a stepwise fashion until return of spontaneous circulation. The pVT rhythm was recognized correctly in 51 out of 52 (98%) opportunities among residents using the app compared to only 19 out of 52 (37%) among those using PALS cards (P<.001). Time to epinephrine injection was similar. Among a total of 78 opportunities, incorrect shock or drug doses occurred in 14% (11/78) of cases among those using the cards. These errors were reduced to 1% (1/78, P=.005) when using the app. Conclusions Use of the mobile app was associated with a shorter time to first and subsequent defibrillation attempts, fewer medication and defibrillation dose errors, and improved adherence to AHA recommendations compared with the use of PALS pocket cards.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.,Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Aymeric Cantais
- Pediatric Emergency Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Frederic Ehrler
- Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland
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12
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Hejjaji V, Malik AO, Peri-Okonny PA, Thomas M, Tang Y, Wooldridge D, Spertus JA, Chan PS. Mobile App to Improve House Officers' Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study. JMIR Mhealth Uhealth 2020; 8:e15762. [PMID: 32427115 PMCID: PMC7267993 DOI: 10.2196/15762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/21/2019] [Accepted: 02/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background Effective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. Objective The aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. Methods As part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. Results Among 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P<.001) as well as fewer incorrect ACLS interventions (mean 0.3 vs 1.0; absolute difference –0.7 [95% CI –0.3 to –1.0]; P<.001). Simulations with the mobile app also had a marginally higher chest compression fraction (mean 90.9% vs 89.0%; absolute difference 1.9% [95% CI 0.6% to 3.4%]; P=.007). Conclusions This proof-of-concept study suggests that this novel mobile app may improve adherence to ACLS protocols, but its effectiveness on survival in real-world resuscitations remains unknown.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Ali O Malik
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Poghni A Peri-Okonny
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Merrill Thomas
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Yuanyuan Tang
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - David Wooldridge
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, MO, United States
| | - John A Spertus
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
| | - Paul S Chan
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, University of Missouri Kansas City, Kansas City, MO, United States
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13
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Crabb DB, Hurwitz JE, Reed AC, Smith ZJ, Martin ET, Tyndall JA, Taasan MV, Plourde MA, Beattie LK. Innovation in resuscitation: A novel clinical decision display system for advanced cardiac life support. Am J Emerg Med 2020; 43:217-223. [PMID: 32291164 DOI: 10.1016/j.ajem.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/12/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION The Advanced Cardiac Life Support (ACLS) Clinical Decision Display System (CDDS) is a novel application designed to optimize team organization and facilitate decision-making during ACLS resuscitations. We hypothesized that resuscitation teams would more consistently adhere to ACLS guideline time intervals in simulated resuscitation scenarios with the CDDS compared to without. METHODS We conducted a simulation-based, non-blinded, randomized, crossover-design study with resuscitation teams comprised of Emergency Medicine physicians, registered nurses, critical care technicians, and paramedics. Each team performed 4 ACLS scenarios in randomized sequences, half with the CDDS and half without. We analyzed the resuscitations and recorded the times of interventions that have defined intervals by ACLS: rhythm checks, epinephrine administration, and shock delivery. In addition, we surveyed each resuscitation team regarding their experience using the CDDS. RESULTS On average, teams performed rhythm checks 4.9 s closer to ACLS guidelines with the CDDS (p = 0.0358). Teams were also more consistent; on average, teams reduced the variation of time between consecutive doses of epinephrine by 45% (p = 0.0001) and defibrillation by 47% (p < 0.0001). Ninety-eight percent of participants indicated they would use the CDDS if available in real cardiac arrests. CONCLUSIONS This study demonstrates that the CDDS improves the accuracy and precision of timed ACLS interventions in a simulated setting. Resuscitation teams were strongly in favor of utilizing the CDDS in clinical practice. Further investigations of the introduction of the platform into real time clinical environments will be needed to assess true efficacy and patient outcomes.
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Affiliation(s)
- David B Crabb
- Dept. of Emergency Medicine, University of Florida College of Medicine (UF COM), Gainesville, FL, United States of America.
| | - Joshua E Hurwitz
- Dept. of Emergency Medicine, UF COM, Gainesville, FL, Present: Roper Saint Francis, Charleston, SC, United States of America.
| | - Austin C Reed
- Dept. of Emergency Medicine, UF COM, Gainesville, FL, United States of America.
| | - Zachary J Smith
- UF Health Shands Hospital, Gainesville, FL, United States of America.
| | - Emmett T Martin
- Dept. of Emergency Medicine, UF COM, Gainesville, FL, United States of America.
| | - J Adrian Tyndall
- Dept. of Emergency Medicine, UF COM, Gainesville, FL, United States of America.
| | - Michael V Taasan
- Dept. of Emergency Medicine, UF COM, Gainesville, FL, United States of America.
| | - Michelle A Plourde
- Previous: Dept. of Emergency Medicine, UF COM, Gainesville, FL, Present: North Florida Regional Medical Center, Gainesville, FL, United States of America
| | - Lars K Beattie
- Dept. of Emergency Medicine, UF COM, Gainesville, FL, United States of America.
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Learners and Luddites in the Twenty-first Century: Bringing Evidence-based Education to Anesthesiology. Anesthesiology 2020; 131:908-928. [PMID: 31365369 DOI: 10.1097/aln.0000000000002827] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Anesthesiologists are both teachers and learners and alternate between these roles throughout their careers. However, few anesthesiologists have formal training in the methodologies and theories of education. Many anesthesiology educators often teach as they were taught and may not be taking advantage of current evidence in education to guide and optimize the way they teach and learn. This review describes the most up-to-date evidence in education for teaching knowledge, procedural skills, and professionalism. Methods such as active learning, spaced learning, interleaving, retrieval practice, e-learning, experiential learning, and the use of cognitive aids will be described. We made an effort to illustrate the best available evidence supporting educational practices while recognizing the inherent challenges in medical education research. Similar to implementing evidence in clinical practice in an attempt to improve patient outcomes, implementing an evidence-based approach to anesthesiology education may improve learning outcomes.
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15
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Clebone A, Strupp KM, Whitney G, Anderson MR, Hottle J, Fehr J, Yaster M, Schleelein LE, Burian BK, Galvez JA, Lockman JL, Polaner D, Barnett NR, Keane MJ, Manikappa S, Gleich S, Greenberg RS, Vincent A, Oswald SL, Starks R, Licata S. Development and Usability Testing of the Society for Pediatric Anesthesia Pedi Crisis Mobile Application. Anesth Analg 2019; 129:1635-1644. [PMID: 31743185 DOI: 10.1213/ane.0000000000003935] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When life-threatening, critical events occur in the operating room, the fast-paced, high-distraction atmosphere often leaves little time to think or deliberate about management options. Success depends on applying a team approach to quickly implement well-rehearsed, systematic, evidence-based assessment and treatment protocols. Mobile devices offer resources for readily accessible, easily updatable information that can be invaluable during perioperative critical events. We developed a mobile device version of the Society for Pediatric Anesthesia 26 Pediatric Crisis paper checklists-the Pedi Crisis 2.0 application-as a resource to support clinician responses to pediatric perioperative life-threatening critical events. Human factors expertise and principles were applied to maximize usability, such as by clustering information into themes that clinicians utilize when accessing cognitive aids during critical events. The electronic environment allowed us to feature optional diagnostic support, optimized navigation, weight-based dosing, critical institution-specific phone numbers pertinent to emergency response, and accessibility for those who want larger font sizes. The design and functionality of the application were optimized for clinician use in real time during actual critical events, and it can also be used for self-study or review. Beta usability testing of the application was conducted with a convenience sample of clinicians at 9 institutions in 2 countries and showed that participants were able to find information quickly and as expected. In addition, clinicians rated the application as slightly above "excellent" overall on an established measure, the Systems Usability Scale, which is a 10-item, widely used and validated Likert scale created to assess usability for a variety of situations. The application can be downloaded, at no cost, for iOS devices from the Apple App Store and for Android devices from the Google Play Store. The processes and principles used in its development are readily applicable to the development of future mobile and electronic applications for the field of anesthesiology.
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Affiliation(s)
- Anna Clebone
- From the Department of Anesthesiology and Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Kim M Strupp
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Gina Whitney
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | | | | | - James Fehr
- Departments of Anesthesiology
- Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, St Louis, Missouri
| | - Myron Yaster
- Department of Anesthesiology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Laura E Schleelein
- Departments of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara K Burian
- United States National Aeronautics and Space Administration, Ames Research Center, Moffett Field, California
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16
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Ergonomic Challenges Inherent in Neonatal Resuscitation. CHILDREN-BASEL 2019; 6:children6060074. [PMID: 31163596 PMCID: PMC6617094 DOI: 10.3390/children6060074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
Neonatal resuscitation demands that healthcare professionals perform cognitive and technical tasks while working under time pressure as a team in order to provide efficient and effective care. Neonatal resuscitation teams simultaneously process and act upon multiple data streams, perform ergonomically challenging technical procedures, and coordinate their actions within a small physical space. An understanding and application of human factors and ergonomics science broadens the areas of need in resuscitation research, and will lead to enhanced technologies, systems, and work environments that support human limitations and maximize human performance during neonatal resuscitation.
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17
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Alexander LA, Newton MW, McEvoy KG, Newton MJ, Mungai M, DiMiceli-Zsigmond M, Sileshi B, Watkins SC, McEvoy MD. Development and Pilot Testing of a Context-Relevant Safe Anesthesia Checklist for Cesarean Delivery in East Africa. Anesth Analg 2019; 128:993-998. [DOI: 10.1213/ane.0000000000003874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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A Simulation-Based Pilot Study of a Mobile Application (NRP Prompt) as a Cognitive Aid for Neonatal Resuscitation Training. ACTA ACUST UNITED AC 2019; 14:146-156. [DOI: 10.1097/sih.0000000000000353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Yoon CH, Ritchie SR, Duffy EJ, Thomas MG, McBride S, Read K, Chen R, Humphrey G. Impact of a smartphone app on prescriber adherence to antibiotic guidelines in adult patients with community acquired pneumonia or urinary tract infections. PLoS One 2019; 14:e0211157. [PMID: 30695078 PMCID: PMC6350960 DOI: 10.1371/journal.pone.0211157] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/08/2019] [Indexed: 01/22/2023] Open
Abstract
Background Mobile phone apps have been shown to enhance guideline adherence by prescribers, but have not been widely evaluated for their impact on guideline adherence by prescribers caring for inpatients with infections. Objectives To determine whether providing the Auckland City Hospital (ACH) antibiotic guidelines in a mobile phone app increased guideline adherence by prescribers caring for inpatients with community acquired pneumonia (CAP) or urinary tract infections (UTIs). Methods We audited antibiotic prescribing during the first 24 hours after hospital admission in adults admitted during a baseline and an intervention period to determine whether provision of the app increased the level of guideline adherence. To control for changes in prescriber adherence arising from other factors, we performed similar audits of adherence to antibiotic guidelines in two adjacent hospitals. Results The app was downloaded by 145 healthcare workers and accessed a total of 3985 times during the three month intervention period. There was an increase in adherence to the ACH antibiotic guidelines by prescribers caring for patients with CAP from 19% (37/199) to 27% (64/237) in the intervention period (p = 0.04); but no change in guideline adherence at an adjacent hospital. There was no change in adherence to the antibiotic guidelines by prescribers caring for patients with UTI at ACH or at the two adjacent hospitals. Conclusions Provision of antibiotic guidelines in a mobile phone app can significantly increase guideline adherence by prescribers. However, providing an app which allows easy access to antibiotic guidelines is not sufficient to achieve high levels of prescriber adherence.
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Affiliation(s)
- Chang Ho Yoon
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Stephen R. Ritchie
- Auckland District Health Board, Grafton, Auckland, New Zealand
- School of Medical Sciences, University of Auckland, Grafton, Auckland, New Zealand
- * E-mail:
| | - Eamon J. Duffy
- Auckland District Health Board, Grafton, Auckland, New Zealand
| | - Mark G. Thomas
- Auckland District Health Board, Grafton, Auckland, New Zealand
- School of Medical Sciences, University of Auckland, Grafton, Auckland, New Zealand
| | - Stephen McBride
- Counties Manukau District Health Board, Otahuhu, Auckland, New Zealand
| | - Kerry Read
- Waitemata District Health Board, Takapuna, Auckland, New Zealand
| | - Rachel Chen
- National Institute for Health Innovation, University of Auckland, Glen Innes, Auckland, New Zealand
| | - Gayl Humphrey
- National Institute for Health Innovation, University of Auckland, Glen Innes, Auckland, New Zealand
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20
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Huang MY, Kung LC, Hou SW, Lee YK, Su YC. Comparison of the validity of checklist assessment in cardiac arrest simulations with an app in an academic hospital in Taiwan: a retrospective observational study. BMJ Open 2018; 8:e024309. [PMID: 30552278 PMCID: PMC6303606 DOI: 10.1136/bmjopen-2018-024309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Robust assessment is a crucial component in Advanced Cardiac Life Support (ACLS) training to determine whether participants have achieved learning objectives with little or no variation in their overall outcomes. This study aimed to evaluate resuscitation performance by real-time logs. We hypothesised that instructors may not be able to evaluate time-sensitive parameters, namely, chest compression fraction, time to initiating chest compression and time to initiating defibrillation accurately in a subjective manner. METHODS Video records and formal checklist-based test results of Megacode scenarios for the ACLS certification examination at several hospitals in Taipei were examined. For the study interest, three time-sensitive parameters were measured via video review assisted by a mobile phone application, and were used for evaluation. We evaluated if the pass/fail results made by instructors via checklists were correlated with these parameters. RESULTS A total of 185 Megacode scenarios were eligible for the final analysis. Among the three parameters, good chest compression fraction was statistically significant with a higher OR of passing (OR=3.65; 95% CI 1.36 to 9.91; p=0.01). In 112 participants with one parameter that did not meet the criteria, 25 were graded as fail, making the specificity 22.3% (95% CI 15.0% to 31.2%). CONCLUSIONS Visual observation of cardiopulmonary resuscitation performance is not accurate when evaluating time-sensitive parameters. Objective results should be offered for training outcome evaluation, and also for feedback to participants.
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Affiliation(s)
- Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Lu-Chih Kung
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, Taipei, Taiwan
| | - Sheng-Wen Hou
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yi-Kung Lee
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yung-Cheng Su
- Emergency Department, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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21
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Yamada NK, Kamlin COF, Halamek LP. Optimal human and system performance during neonatal resuscitation. Semin Fetal Neonatal Med 2018; 23:306-311. [PMID: 29571705 DOI: 10.1016/j.siny.2018.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Performance in the delivery of care to sick neonates in need of resuscitation has long been defined primarily in terms of the extent of the knowledge possessed and hands-on skill demonstrated by physicians and other healthcare professionals. This definition of performance in neonatal resuscitation is limited by its focus solely on the human beings delivering care and a perceived set of the requisite skills to do so. This manuscript will expand the definition of performance to include all of the skill sets that humans must use to resuscitate newborns as well as the often complex systems in which those humans operate while delivering that care. It will also highlight how the principles of human factors and ergonomics can be used to enhance human and system performance during patient care. Finally, it will describe the role of simulation and debriefing in the assessment of human and system performance.
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Affiliation(s)
- N K Yamada
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Palo Alto, CA, USA.
| | - C O F Kamlin
- Royal Women's Hospital and Newborn Research, Parkville, Victoria, Australia
| | - L P Halamek
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Palo Alto, CA, USA
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22
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Lee CH, Huang MY, Lee YK, Hsu CY, Su YC. Implementation of a real-time qualitative app to evaluate resuscitation performance in an Advanced Cardiac Life Support course. Tzu Chi Med J 2018; 30:165-168. [PMID: 30069125 PMCID: PMC6047333 DOI: 10.4103/tcmj.tcmj_103_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: In addition to high-quality chest compression, parameters of resuscitation efficiency such as early chest compression, early defibrillation, and decreased hands-off time are also vital in the Advanced Cardiac Life Support (ACLS) protocol. However, because of limited time and equipment in ACLS courses, efficiency of performance is difficult to evaluate. Materials and Methods: A free, easy-to-use iOS and Android app (CodeTracer®) was developed for real-time recording of cardiopulmonary resuscitation (CPR) performance. Interventions performed during resuscitation were set up as buttons. When the simulated scenario in the ACLS course began, instructors recorded every intervention and the team performed by pushing the appropriate buttons. When the scenario ended, the CodeTracer® automatically computed parameters, including the percentage of no-flow time, time to initiating CPR, and time to initiating defibrillation and also generated a graphic log for later discussion. Results: A total of 76 resuscitation episodes were recorded, 27 in the practice scenarios and 49 in the final Megacode simulations. After the course, the average percentage of no-flow time decreased 5.79%, time to initiating CPR decreased 3.05 s, and time to initiating defibrillation decreased up to 20.27 s. Of note, physicians as leaders seem to have better performance after the ACLS course than before, but the results were insignificant except for the percentage of no-flow time. Conclusions: CodeTracer® can record and calculate objective parameters for resuscitation performance in ACLS courses and can assist instructors in disseminating important concepts to participants. It can be a useful tool in ACLS courses.
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Affiliation(s)
- Chao-Hsiung Lee
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ming-Yuan Huang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yi-Kung Lee
- Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chen-Yang Hsu
- Department of Public Heath, National Taiwan University, Taipei, Taiwan
| | - Yung-Cheng Su
- Department of Emergency, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
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Kazior MR, Wang J, Stiegler MP, Nguyen D, Rebel A, Isaak RS. Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2017; 19:E608. [PMID: 29600255 PMCID: PMC5868369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). METHODS PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. RESULTS The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. CONCLUSIONS The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase).
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Siebert JN, Ehrler F, Gervaix A, Haddad K, Lacroix L, Schrurs P, Sahin A, Lovis C, Manzano S. Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e183. [PMID: 28554878 PMCID: PMC5468544 DOI: 10.2196/jmir.7379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022] Open
Abstract
Background The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world’s most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. Objective The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. Methods We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario—pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Results Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other critical resuscitation endpoints and drug dose delivery were not improved using AR glasses. However, errors and deviations were significantly reduced in terms of defibrillation doses when compared with the use of the PALS pocket reference cards. In a total of 40 defibrillation attempts, residents not wearing AR glasses used wrong doses in 65% (26/40) of cases, including 21 shock overdoses >100 J, for a cumulative defibrillation dose of 18.7 Joules per kg. These errors were reduced by 53% (21/40, P<.001) and cumulative defibrillation dose by 37% (5.14/14, P=.001) with AR glasses. Conclusions AR glasses did not decrease time to first defibrillation attempt and other critical resuscitation endpoints when compared with PALS pocket cards. However, they improved adherence and performance among residents in terms of administering the defibrillation doses set by AHA.
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Affiliation(s)
- Johan N Siebert
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Schrurs
- Geneva Medical Center, University Hospitals of Geneva, Geneva, Switzerland
| | - Ayhan Sahin
- Geneva Medical Center, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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25
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Trevisanuto D, De Bernardo G, Res G, Sordino D, Doglioni N, Weiner G, Cavallin F. Time Perception during Neonatal Resuscitation. J Pediatr 2016; 177:103-107. [PMID: 27499215 DOI: 10.1016/j.jpeds.2016.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 06/03/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the accuracy of time perception during a simulated complex neonatal resuscitation. STUDY DESIGN Participants in 5 neonatal resuscitation program courses were directly involved in a complex simulation scenario. They were asked to assume the role of team leader, assistant 1, or assistant 2. At the end of the scenario, each participant completed a questionnaire on perceived time intervals for key resuscitation interventions. During the scenario, actual times were documented by an external observer and video recorded for later review. In addition, participants were asked to evaluate their self-perceived level of stress and preparation. RESULTS Health care providers (68 physicians and 40 nurses) were involved in 36 scenarios. Perceived time intervals for the initiation of key resuscitation interventions were shorter than the actual time intervals, regardless of the participant's role in the scenario. Self-assessed levels of stress and preparation did not influence time perception. CONCLUSIONS Health care providers underestimate the passage of time, irrespective of their role in a simulated complex neonatal resuscitation. Participant's self-assessed levels of stress and preparation were not related to the accuracy of their time perception. These findings highlight the importance of assigning a dedicated individual to document interventions and the passage of time during a neonatal resuscitation.
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Affiliation(s)
- Daniele Trevisanuto
- Department of Women's and Children's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy.
| | | | - Giulia Res
- Department of Women's and Children's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy
| | | | - Nicoletta Doglioni
- Department of Women's and Children's Health, Maternal-Fetal Medicine Unit, University of Padua School of Medicine, Padua, Italy
| | - Gary Weiner
- Department of Pediatrics, Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, MI
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Hession PM, Millward CJ, Gottesfeld JE, Rehring TF, Miller KB, Chetham PM, Muckleroy SK, Bates CA, Hollis HW. Amniotic Fluid Embolism: Using the Medical Staff Process to Facilitate Streamlined Care. Perm J 2016; 20:15-248. [PMID: 27541321 PMCID: PMC5101097 DOI: 10.7812/tpp/15-248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Amniotic fluid embolism (AFE) is a catastrophic consequence of labor and delivery that often results in maternal and neonatal death. These poor outcomes are related largely to the rarity of the event in a population overwhelmingly biased by overall good health. Despite the presence of national AFE registries, there are no published algorithmic approaches to its management, to our knowledge. The purpose of this article is to share a care pathway developed by a multidisciplinary group at a community teaching hospital. Post hoc analysis of a complicated case of AFE resulted in development of this pathway, which addresses many of the major consequences of AFE. We offer this algorithm as a template for use by any institution willing to implement a clinical pathway to treat AFE. It is accompanied by the remarkable case outcome that prompted its development.
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Affiliation(s)
- Peter M Hession
- Cardiac Anesthesiologist at Saint Joseph Hospital in Denver, CO.
| | - Cynthia J Millward
- Chief Resident in General Surgery at Saint Joseph Hospital in Denver, CO.
| | - Joyce E Gottesfeld
- Attending Obstetrician/Gynecologist at the Franklin Medical Center in Denver, CO.
| | - Thomas F Rehring
- Director of Quality, Colorado Permanente Medical Group in Denver.
| | | | - Paul M Chetham
- Cardiac Anesthesiologist at the Franklin Medical Center in Denver, CO.
| | - S Kel Muckleroy
- General Surgeon at the Englewood Medical Center in Denver, CO.
| | - Christopher A Bates
- Critical Care Pulmonologist in the Department of Critical Care Pulmonology and Sleep Apnea at the Franklin Medical Center in Denver, CO.
| | - Harris W Hollis
- Senior Research Advisor in the Department of Graduate Medical Education: General Surgery at Saint Joseph Hospital in Denver, CO.
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A Smartphone-based Decision Support Tool Improves Test Performance Concerning Application of the Guidelines for Managing Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy. Anesthesiology 2016; 124:186-98. [PMID: 26513023 DOI: 10.1097/aln.0000000000000885] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Society of Regional Anesthesia and Pain Medicine (ASRA) consensus statement on regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy is the standard for evaluation and management of these patients. The authors hypothesized that an electronic decision support tool (eDST) would improve test performance compared with native physician behavior concerning the application of this guideline. METHODS Anesthesiology trainees and faculty at 8 institutions participated in a prospective, randomized trial in which they completed a 20-question test involving clinical scenarios related to the ASRA guidelines. The eDST group completed the test using an iOS app programmed to contain decision logic and content of the ASRA guidelines. The control group completed the test by using any resource in addition to the app. A generalized linear mixed-effects model was used to examine the effect of the intervention. RESULTS After obtaining institutional review board's approval and informed consent, 259 participants were enrolled and randomized (eDST = 122; control = 137). The mean score was 92.4 ± 6.6% in the eDST group and 68.0 ± 15.8% in the control group (P < 0.001). eDST use increased the odds of selecting correct answers (7.8; 95% CI, 5.7 to 10.7). Most control group participants (63%) used some cognitive aid during the test, and they scored higher than those who tested from memory alone (76 ± 15% vs. 57 ± 18%, P < 0.001). There was no difference in time to completion of the test (P = 0.15) and no effect of training level (P = 0.56). CONCLUSIONS eDST use improved application of the ASRA guidelines compared with the native clinician behavior in a testing environment.
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Clarke S, Carolina Apesoa-Varano E, Barton J. Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest. BMJ Open 2016; 6:e009259. [PMID: 26758258 PMCID: PMC4716199 DOI: 10.1136/bmjopen-2015-009259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In-hospital cardiac arrest (IHCA) is a particularly vexing entity from the perspective of preparedness, as it is neither common nor truly rare. Survival from IHCA requires the coordinated efforts of multiple providers with different skill sets who may have little prior experience working together. Survival rates have remained low despite advances in therapy, suggesting that human factors may be at play. METHODS AND ANALYSIS This qualitative study uses a quasiethnographic data collection approach combining focus group interviews with providers involved in IHCA resuscitation as well as analysis of video recordings from in situ-simulated cardiac arrest events. Using grounded theory-based analysis, we intend to understand the organisational, interpersonal, cognitive and behavioural dimensions of IHCA resuscitation, and to build a descriptive model of code team functioning. ETHICS AND DISSEMINATION This ongoing study has been approved by the IRB at UC Davis Medical Center. RESULTS The results will be disseminated in a subsequent manuscript.
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Affiliation(s)
- Samuel Clarke
- Department of Emergency Medicine, UC Davis Medical Center, Sacramento, California, USA
| | | | - Joseph Barton
- Department of Emergency Medicine, Queen of the Valley Medical Center, Napa, California, USA
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29
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Initial Experience of the American Society of Regional Anesthesia and Pain Medicine Coags Regional Smartphone Application. Reg Anesth Pain Med 2016; 41:334-8. [DOI: 10.1097/aap.0000000000000391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Cognitive aids and other methods of decision support are receiving increased interest by the anesthesia community. These tools have significant safety implications because of the possibility to decrease variability in human performance. RECENT FINDINGS Studies of the use of cognitive aids during realistic simulations supports use of cognitive aids and other decision support tools. SUMMARY The early work in this field of decision support is encouraging but there are many questions regarding the optimal design, presentation and use.
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Watkins SC, Anders S, Clebone A, Hughes E, Zeigler L, Patel V, Shi Y, Shotwell MS, McEvoy M, Weinger MB. Paper or plastic? Simulation based evaluation of two versions of a cognitive aid for managing pediatric peri-operative critical events by anesthesia trainees: evaluation of the society for pediatric anesthesia emergency checklist. J Clin Monit Comput 2015; 30:275-83. [DOI: 10.1007/s10877-015-9714-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
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Dilley SJ, Weiland TJ, O'Brien R, Cunningham NJ, Van Dijk JE, Mahoney RM, Williams MJ. Use of a checklist during observation of a simulated cardiac arrest scenario does not improve time to CPR and defibrillation over observation alone for subsequent scenarios. TEACHING AND LEARNING IN MEDICINE 2015; 27:71-79. [PMID: 25584474 DOI: 10.1080/10401334.2014.979182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
THEORY Immersive simulation is a common mode of education for medical students. Observation of clinical simulations prior to participation is believed to be beneficial, though this is often a passive process. Active observation may be more beneficial. HYPOTHESES The hypothesis tested in this study was that the active use of a simple checklist during observation of an immersive simulation would result in better participant performance in a subsequent scenario compared with passive observation alone. METHODS Medical students were randomized to either passive or active (with checklist) observation of an immersive simulation involving cardiac arrest prior to participating in their own simulation. Performance measures included time to cardiopulmonary resuscitation (CPR) and time to defibrillation and were compared between first and second scenarios as well as between passive and active observers. RESULTS Seventy-nine simulations involving 232 students were conducted. Mean time to CPR was 18 seconds (SD = 11.6) for those using the checklist and 24 seconds (SD = 15.8) for those who observed passively (M difference = 6 seconds), t(35) = 1.46, p =.153. Time to defibrillation was 94 seconds (SD = 26.4) for those using the checklist and 92 seconds (SD = 23.8) for those who observed passively (M difference = -2 seconds), t(38) =.21, p =.837. Time to CPR was 24 seconds (SD = 15.8) for passive observers and 31 seconds (SD = 21.0; M difference = 7 seconds), t(35) = 1.13, p =.265, for their first scenario counterparts. Time to CPR was 18 seconds (SD = 11.6) for active observers and 36 seconds (SD = 26.2; M difference = 18 seconds), t(24) = 2.81, p =.010, for their first scenario counterparts. Time to defibrillation was 92 seconds (SD = 23.8) for passive observers and 125 seconds (SD = 32.2; M difference = 33 seconds), t(33) = 3.63, p =.001, for their first scenario counterparts. Time to defibrillation was 94 seconds (SD = 26.4) for the active observers and 132 seconds (SD = 52.9; M difference = 38 seconds), t(28) =.46, p =.008, for their first scenario counterparts. CONCLUSIONS Observation alone leads to improved performance in the management of a simulated cardiac arrest. The active use of a simple skills-based checklist during observation did not appear to improve performance over passive observation alone.
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Affiliation(s)
- Stuart J Dilley
- a Clinical Education and Simulation Centre, University of Melbourne Department of Medicine, St. Vincent's Hospital Melbourne, Melbourne , Victoria , Australia
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Fuerch JH, Yamada NK, Coelho PR, Lee HC, Halamek LP. Impact of a novel decision support tool on adherence to Neonatal Resuscitation Program algorithm. Resuscitation 2014; 88:52-6. [PMID: 25555358 DOI: 10.1016/j.resuscitation.2014.12.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 12/02/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
AIM Studies have shown that healthcare professionals (HCPs) display a 16-55% error rate in adherence to the Neonatal Resuscitation Program (NRP) algorithm. The aim of this study was to evaluate adherence to the Neonatal Resuscitation Program algorithm by subjects working from memory as compared to subjects using a decision support tool that provides auditory and visual prompts to guide implementation of the Neonatal Resuscitation Program algorithm during simulated neonatal resuscitation. METHODS Healthcare professionals (physicians, nurse practitioners, obstetrical/neonatal nurses) with a current NRP card were randomized to the control or intervention group and performed three simulated neonatal resuscitations. The scenarios were evaluated for the initiation and cessation of positive pressure ventilation (PPV) and chest compressions (CC), as well as the frequency of FiO2 adjustment. The Wilcoxon rank sum test was used to compare a score measuring the adherence of the control and intervention groups to the Neonatal Resuscitation Program algorithm. RESULTS Sixty-five healthcare professionals were recruited and randomized to the control or intervention group. Positive pressure ventilation was performed correctly 55-80% of the time in the control group vs. 94-95% in the intervention group across all three scenarios (p<0.0001). Chest compressions were performed correctly 71-81% of the time in the control group vs. 82-93% in the intervention group in the two scenarios in which they were indicated (p<0.0001). FiO2 was addressed three times more frequently in the intervention group compared to the control group (p<0.001). CONCLUSIONS Healthcare professionals using a decision support tool exhibit significantly fewer deviations from the Neonatal Resuscitation Program algorithm compared to those working from memory alone during simulated neonatal resuscitation.
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Affiliation(s)
- Janene H Fuerch
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States.
| | - Nicole K Yamada
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | | | - Henry C Lee
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Louis P Halamek
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
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