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Bruinink LJ, Linders M, de Boode WP, Fluit CRMG, Hogeveen M. The ABCDE approach in critically ill patients: A scoping review of assessment tools, adherence and reported outcomes. Resusc Plus 2024; 20:100763. [PMID: 39345661 PMCID: PMC11437753 DOI: 10.1016/j.resplu.2024.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/14/2024] [Accepted: 08/23/2024] [Indexed: 10/01/2024] Open
Abstract
Aim The systematic Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is a priority-based consensus approach for the primary assessment of all categories of critically ill or injured patients. The aims of this review are to provide a wide overview of all relevant literature about existing ABCDE assessment tools, adherence to the ABCDE approach and related outcomes of teaching or application of the ABCDE approach by healthcare professionals. Methods A comprehensive scoping review was conducted following the Joanna Briggs Institute guidelines and reported according to the PRISMA-ScR Checklist. An a priori protocol was developed. In March 2024, MEDLINE, EMBASE, CINAHL and Cochrane library were searched to identify studies describing healthcare professionals applying the ABCDE approach in either simulation settings or clinical practice. Two reviewers independently screened records for inclusion and performed data extraction. Results From n = 8165 results, fifty-seven studies met the inclusion criteria and reported data from clinical care (n = 27) or simulation settings (n = 30). Forty-two studies reported 39 different assessment tools, containing 5 to 36 items. Adherence to the approach was reported in 43 studies and varied from 18-84% in clinical practice and from 29-35% pre-intervention to 65-97% post-intervention in simulation settings. Team leader presence and attending simulation training improved adherence. Data on patient outcomes were remarkably scarce. Conclusion Many different tools with variable content were identified to assess the ABCDE approach. Adherence was the most frequently reported outcome and varied widely among included studies. However, association between the ABCDE approach and patient outcomes is yet to be investigated.
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Affiliation(s)
- Laura J Bruinink
- Radboud University Medical Center, Amalia Children's Hospital, Department of Paediatrics, Nijmegen, The Netherlands
| | - Marjolein Linders
- Radboud University Medical Center, Amalia Children's Hospital, Department of Paediatrics, Nijmegen, The Netherlands
| | - Willem P de Boode
- Radboud University Medical Center, Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Nijmegen, The Netherlands
| | - Cornelia R M G Fluit
- Radboud University Medical Center, Radboudumc Health Academy, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Radboud University Medical Center, Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Nijmegen, The Netherlands
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Botelho F, Truché P, Caddell L, de Campos Vieira Abib S, Bowder AN, Faria I, Zimmerman K, Alonso N, de Caux M, Bentes A, Buda A, Roa L, Mooney DP. Implementation of a checklist to improve pediatric trauma assessment quality in a Brazilian hospital. Pediatr Surg Int 2021; 37:1339-1348. [PMID: 34128087 DOI: 10.1007/s00383-021-04941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Trauma is the leading cause of death among children and adolescents in Brazil. Measurement of quality of care is important, as well as interventions that will help optimize treatment. We aimed to evaluate adherence to standardized trauma care following the introduction of a checklist in one of the busiest Latin American trauma centers. MATERIAL AND METHODS A prospective, non-randomized interventional trial was conducted. Assessment of children younger than age 15 was performed before and after the introduction of a checklist for trauma primary survey assessment. Over the study period, each trauma primary survey was observed and adherence to each step of a standardized primary assessment protocol was recorded. Clinical outcomes including mortality, admission to pediatric intensive-care units, use of blood products, mechanical ventilation, and number of CT scans in the first 24 h were also assessed. RESULTS A total of 80 patients were observed (39 pre-intervention and 41 post-intervention). No statistically significant differences were observed between the pre- and post-intervention groups in regard to adherence to checklist by specialty (57.7% versus 50.5%, p = 0.115) and outcomes. No mortality was observed. CONCLUSION In our trauma center, the quality of the adherence to standardized trauma assessment protocols is poor among both surgical and non-surgical providers. The quality of this assessment did not improve after the introduction of a checklist. Further work aimed at organizing the approach to pediatric trauma including triage and trauma education specifically for pediatric providers is needed.
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Affiliation(s)
- Fabio Botelho
- Departamento de Cirurgia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Alfredo Balena 110, 6 Oeste, Belo Horizonte, MG, Brazil. .,Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Paul Truché
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | | | - Alexis N Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Isabella Faria
- Departamento de Cirurgia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Alfredo Balena 110, 6 Oeste, Belo Horizonte, MG, Brazil
| | - Kathrin Zimmerman
- Departamento de Cirurgia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Alfredo Balena 110, 6 Oeste, Belo Horizonte, MG, Brazil
| | - Nivaldo Alonso
- Departamento de Cirurgia Plastica, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana de Caux
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Bentes
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandra Buda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - David P Mooney
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
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Young AL, Doughty CB, Williamson KC, Won SK, Rus MC, Villarreal NN, Camp EA, Lemke DS. Workload of learners during simulated paediatric cardiopulmonary resuscitation. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:338-344. [PMID: 35515742 PMCID: PMC8936742 DOI: 10.1136/bmjstel-2020-000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
IntroductionLearner workload during simulated team-based resuscitations is not well understood. In this descriptive study, we measured the workload of learners in different team roles during simulated paediatric cardiopulmonary resuscitation.MethodsPaediatric emergency nurses and paediatric and emergency medicine residents formed teams of four to eight and randomised into roles to participate in simulation-based, paediatric resuscitation. Participant workload was measured using the NASA Task Load Index, which provides an average workload score (from 0 to 100) across six subscores: mental demand, physical demand, temporal demand, performance, frustration and mental effort. Workload is considered low if less than 40, moderate if between 40 and 60 and high if greater than 60.ResultsThere were 210 participants representing 40 simulation teams. 138 residents (66%) and 72 nurses (34%) participated. Team lead reported the highest workload at 65.2±10.0 (p=0.001), while the airway reported the lowest at 53.9±10.8 (p=0.001); team lead had higher scores for all subscores except physical demand. Team lead reported the highest mental demand (p<0.001), while airway reported the lowest. Cardiopulmonary resuscitation coach and first responder reported the highest physical demands (p<0.001), while team lead and nurse recorder reported the lowest (p<0.001).ConclusionsWorkload for learners in paediatric simulated resuscitation teams was moderate to high and varied significantly based on team role. Composition of workload varied significantly by team role. Measuring learner workload during simulated resuscitations allows improved processes and choreography to optimise workload distribution.
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Affiliation(s)
- Ann L Young
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Cara B Doughty
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Kaitlin C Williamson
- Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon K Won
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Marideth C Rus
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Nadia N Villarreal
- Pediatric Emergency Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Elizabeth A Camp
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
| | - Daniel S Lemke
- Section of Emergency Medicine, Baylor College of Medicine Department of Pediatrics, Houston, Texas, USA
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Kulp L, Sarcevic A, Zheng Y, Cheng M, Alberto E, Burd R. Checklist Design Reconsidered: Understanding Checklist Compliance and Timing of Interactions. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2020; 2020. [PMID: 32685940 DOI: 10.1145/3313831.3376853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We examine the association between user interactions with a checklist and task performance in a time-critical medical setting. By comparing 98 logs from a digital checklist for trauma resuscitation with activity logs generated by video review, we identified three non-compliant checklist use behaviors: failure to check items for completed tasks, falsely checking items when tasks were not performed, and inaccurately checking items for incomplete tasks. Using video review, we found that user perceptions of task completion were often misaligned with clinical practices that guided activity coding, thereby contributing to non-compliant check-offs. Our analysis of associations between different contexts and the timing of check-offs showed longer delays when (1) checklist users were absent during patient arrival, (2) patients had penetrating injuries, and (3) resuscitations were assigned to the highest acuity. We discuss opportunities for reconsidering checklist designs to reduce non-compliant checklist use.
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Affiliation(s)
- Leah Kulp
- Drexel University, Philadelphia, PA, USA
| | | | - Yinan Zheng
- Children's National Medical Center, Washington DC, USA
| | - Megan Cheng
- Children's National Medical Center, Washington DC, USA
| | - Emily Alberto
- Children's National Medical Center, Washington DC, USA
| | - Randall Burd
- Children's National Medical Center, Washington DC, USA
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