Perioperative ACLS/Cognitive Aids in Resuscitation

The impact of a smartphone-based cognitive aid on clinical performance during cardiac arrest simulations: A randomized controlled trial

Objectives

In-hospital cardiac arrests are common and associated with high mortality. Smartphone applications offer quick access to algorithms and timers but often lack real-time guidance. This study assesses the impact of the Code Blue Leader application on the performance of providers leading cardiac arrest simulations.

Methods

This open-label randomized controlled trial included Advanced Cardiac Life Support (ACLS)-trained medical doctors (MD) and registered nurses (RN). Participants were randomized to lead the same ACLS simulation with or without the app. The primary outcome, "performance score," was assessed by a trained rater using a validated ACLS scoring system. Secondary outcomes included percentage of critical actions performed, number of incorrect actions, and chest compression fraction (percentage of time spent performing chest compressions). A sample size of 30 participants was calculated to detect a difference of 20% at the 0.05 alpha level with 90% power.

Results

Fifteen MDs and 15 RNs underwent stratified randomization. The median (interquartile range) performance score in the app group was 95.3% (93.0%-100.0%) compared to 81.4% (60.5%-88.4%) in the control group, demonstrating an effect size of r = 0.69 (Z = -3.78, r = 0.69, p = 0.0002). The percentage of critical actions performed in the app group was 100% (96.2%-100.0%) compared to 85.0% (74.1%-92.4%) in the control group. The number of incorrect actions performed in the app group was 1 (1) compared to 4 (3-5) in the control group. Chest compression fraction in the app group was 75.5% (73.0%-84.0%) compared to 75.0% (72.0%-85.0%) in the control group.

Conclusions

The Code Blue Leader smartphone app significantly improved the performance of ACLS-trained providers in cardiac arrest simulations.

Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments

OBJECTIVE

Understand the perceived role of electronic health records (EHR) and workflow fragmentation on clinician documentation burden in the emergency department (ED).

METHODS

From February to June 2022, we conducted semistructured interviews among a national sample of US prescribing providers and registered nurses who actively practice in the adult ED setting and use Epic Systems' EHR. We recruited participants through professional listservs, social media, and email invitations sent to healthcare professionals. We analyzed interview transcripts using inductive thematic analysis and interviewed participants until we achieved thematic saturation. We finalized themes through a consensus-building process.

RESULTS

We conducted interviews with 12 prescribing providers and 12 registered nurses. Six themes were identified related to EHR factors perceived to contribute to documentation burden including lack of advanced EHR capabilities, absence of EHR optimization for clinicians, poor user interface design, hindered communication, increased manual work, and added workflow blockages, and five themes associated with cognitive load. Two themes emerged in the relationship between workflow fragmentation and EHR documentation burden: underlying sources and adverse consequences.

DISCUSSION

Obtaining further stakeholder input and consensus is essential to determine whether these perceived burdensome EHR factors could be extended to broader contexts and addressed through optimizing existing EHR systems alone or through a broad overhaul of the EHR's architecture and primary purpose.

CONCLUSION

While most clinicians perceived that the EHR added value to patient care and care quality, our findings underscore the importance of designing EHRs that are in harmony with ED clinical workflows to alleviate the clinician documentation burden.

Intraoperative Cardiac Arrest

Cardiac arrest in the operating room and in the immediate postoperative period is a potentially catastrophic event that is almost always witnessed and is frequently anticipated. Perioperative crises and perioperative cardiac arrest, although often catastrophic, are frequently managed in a timely and directed manner because practitioners have a deep knowledge of the patient's medical condition and details of recent procedures. It is hoped that the approaches described here, along with approaches for the rapid identification and management of specific high-stakes clinical scenarios, will help anesthesiologists continue to improve patient outcomes.