Checklists and Other Cognitive Aids For Emergency And Routine Anesthesia Care-A Survey on the Perception of Anesthesia Providers From a Large Academic US Institution

Australian Dentist's Knowledge and Perceptions of Factors Affecting Radiographic Interpretation

BACKGROUND

Errors of interpretation of radigraphic images, also known as interpretive errors, are a critical concern as they can have profound implications for clinical decision making. Different types of interpretive errors, including errors of omission and misdiagnosis, have been described in the literature. These errors can lead to unnecessary or harmful treat/or prolonged patient care. Understanding the nature and contributing factors of interpretive errors is important in developing solutions to minimise interpretive errors. By exploring the knowledge and perceptions of dental practitioners, this study aimed to shed light on the current understanding of interpretive errors in dentistry.

METHODS

An anonymised online questionnaire was sent to dental practitioners in New South Wales (NSW) between September 2020 and March 2022. A total of 80 valid responses were received and analysed. Descriptive statistics and bivariate analysis were used to analyse the data.

RESULTS

The study found that participants commonly reported interpretive errors as occurring 'occasionally', with errors of omission being the most frequently encountered type. Participants identified several factors that most likely contribute to interpretive errors, including reading a poor-quality image, lack of clinical experience and knowledge, and excessive workload. Additionally, general practitioners and specialists held different views regarding factors affecting interpretive errors.

CONCLUSION

The survey results indicate that dental practitioners are aware of the common factors associated with interpretive errors. Errors of omission were identified as the most common type of error to occur in clinical practice. The findings suggest that interpretive errors result from a mental overload caused by factors associated with image quality, clinician-related, and image interpretation. Managing and identifying solutions to mitigate these factors are crucial for ensuring accurate and timely radiographic diagnoses. The findings of this study can serve as a foundation for future research and the development of targeted interventions to enhance the accuracy of radiographic interpretations in dentistry.

Factors affecting interpretation of dental radiographs

OBJECTIVES

To identify the factors influencing errors in the interpretation of dental radiographs.

METHODS

A protocol was registered on Prospero. All studies published until May 2022 were included in this review. The search of the electronic databases spanned Ovid Medline, PubMed, EMBASE, Web of Science and Scopus. The quality of the studies was assessed using the MMAT tool. Due to the heterogeneity of the included studies, a meta-analysis was not conducted.

RESULTS

The search yielded 858 articles, of which eight papers met the inclusion and exclusion criteria and were included in the systematic review. These studies assessed the factors influencing the accuracy of the interpretation of dental radiographs. Six factors were identified as being significant that affected the occurrence of interpretation errors. These include clinical experience, clinical knowledge, and technical ability, case complexity, time pressure, location and duration of dental education and training and cognitive load.

CONCLUSIONS

The occurrence of interpretation errors has not been widely investigated in dentistry. The factors identified in this review are interlinked. Further studies are needed to better understand the extent of the occurrence of interpretive errors and their impact on the practice of dentistry.

Incidence and characteristics of errors detected by a short team briefing in pediatric anesthesia

BACKGROUND

In our institution, a modified WHO surgical safety checklist was implemented more than ten years ago. In retrospect, we noticed that pediatric anesthesia was underrepresented in our surgical safety checklist modification. Therefore, we added a standardized team briefing (pedSOAP-M) immediately before induction of anesthesia and hypothesized that the use of this checklist was effective to detect relevant errors with potentially harmful consequences.

AIMS

The primary aim was to assess the incidence and characteristics of the detected errors, and the secondary aim was to identify factors influencing error detection.

METHODS

This prospective observational study was performed between November 2020 and October 2021 in five operation rooms at the Children's Hospital of Hannover Medical School, Germany. The subcategories of the pedSOAP-M checklist were suction, oxygen, airway, pharmaceuticals, and monitoring. Demographic and procedure-related data and the briefing results were documented anonymously and undated, using a standardized case report form.

RESULTS

We enrolled 1030 and analyzed 1025 patients (aged 0-18 years). Relevant errors were detected in 111 (10.8%) cases (suction 2.5%, oxygen 3.0%, airway 0.2%, pharmaceuticals 2.4%, monitoring 3.0%). In the pharmaceuticals subcategory, the most common error was entering a wrong patient weight into the perfusor syringe pumps. Experienced anesthetists detected significantly more errors than less experienced ones.

CONCLUSION

The briefing tool pedSOAP-M was effective in detecting relevant errors with potentially harmful consequences. The presence of an experienced anesthetist was associated with a higher efficacy of the briefing. Particular attention should be given to entering patient weight into the anesthesia workstation and the perfusor syringe pumps.

Surgical safety checklists for dental implant surgeries-a scoping review

OBJECTIVES

In both elective surgeries and aviation, a reduction of complications can be expected by paying attention to the so-called human factors. Checklists are a well-known way to overcome some of these problems. We aimed to evaluate the current evidence regarding the use of checklists in implant dentistry.

METHODS

An electronic literature search was conducted in the following databases: CINHAL, Medline, Web of Science, and Cochrane Library until March 2022. Based on the results and additional literature, a preliminary checklist for surgical implant therapy was designed.

RESULTS

Three publications dealing with dental implants and checklists were identified. One dealt with the use of a checklist in implant dentistry and was described as a quality assessment study. The remaining two studies offered suggestions for checklists based on literature research and expert opinion.

CONCLUSIONS

Based on our results, the evidence for the use of checklists in dental implantology is extremely low. Considering the great potential, it can be stated that there is a need to catch up. While creating a new implant checklist, we took care of meeting the criteria for high-quality checklists. Future controlled studies will help to place it on a broad foundation.

CLINICAL RELEVANCE

Checklists are a well-known way to prevent complications. They are especially established in aviation, but many surgical specialties and anesthesia adopt this successful concept. As implantology has become one of the fastest-growing areas of dentistry, it is imperative that checklists become an integral part of it.

Pharmacology Course Redesign Using High-Impact Practices

BACKGROUND

Although pharmacology serves as a foundation for health care professions, a gap exists between education and the clinical application. Experiential learning has demonstrated benefit when integrated into pharmacology courses; however, professors struggle with the challenge of incorporating active learning modalities into traditional lecture courses.

METHOD

Active learning and high-impact educational practices, based on cognitive theory, were incorporated into a pharmacology course sequence. After course completion and entry into the clinical setting, qualitative data were collected from students and clinical preceptors.

RESULTS

Students and clinical preceptors reported an improvement in students' ability to recall and apply concepts clinically. Students identified the creation of cognitive aids as the most advantageous measure.

CONCLUSION

Integrating active learning and high-impact educational practices into pharmacology courses could potentially aid in the ability to recall and apply concepts clinically, reduce medication errors and expenditures, and increase student confidence when entering clinical education. [J Nurs Educ. 2021;60(9):529-533.].

Pre-induction checklists and discomfort in patients. An observational study

BACKGROUND

Since the WHO release of the Safe Surgery Saves Lives Program in 2008, peri-operative checklists minimise errors and improve patient safety worldwide. Anaesthesia professionals are often reluctant to use these checklists in front of patients because they fear causing patients' discomfort before anaesthesia and surgery.

OBJECTIVE

To assess and compare the subjective level of patient discomfort caused by the use of pre-induction checklists with the patient discomfort estimated by anaesthesia providers.

DESIGN

Prospective observational study.

SETTING

The current single-centre trial included 110 anaesthesia providers and 125 nonpremedicated ear, nose and throat or maxillofacial surgery patients in Switzerland from June to August 2016. Inclusion criterion: signed general research consent.

EXCLUSION CRITERIA

received premedication, less than 18 years old, day-care patients, dementia or other mental illnesses.

INTERVENTIONS

Anaesthesia healthcare providers and patients before surgery and on the first postoperative day were asked to rate three statements: MAIN OUTCOME MEASURES: All statements were rated on a 100-mm visual analogue scale, where 0 meant no agreement and 100 meant total agreement.

RESULTS

Patients overwhelmingly agreed that anaesthesia providers should use checklists in front of them. Anaesthesia providers rated the patient discomfort much higher than actually perceived by patients. Both, patients and anaesthesia providers rated the possibility of reducing the risk of errors high.

CONCLUSION

Patients experience far less discomfort observing the use of pre-induction checklists than anaesthesia providers expect. Patients value the potential safety benefit significantly higher than anaesthesia providers. These results further support the implementation of peri-operative checklists in the operating room environment.

TRIAL REGISTRATION

The current observational study had no intervention, therefore, was not registered.

ABCDE cognitive aid tool in patient assessment - development and validation in a multicenter pilot simulation study

Background

The so called ABCDE approach (Airway-Breathing-Circulation-Disability-Exposure) is a golden standard of patient assessment. The efficacy of using cognitive aids (CA) in resuscitation and peri-arrest situations remains an important knowledge gap. This work aims to develop an ABCDE CA tool (CAT) and study its potential benefits in patient condition assessment.

Methods

The development of the ABCDE CAT was done by 3 rounds of modified Delphi method performed by the members of the Advanced Life Support Science and Education Committee of the European Resuscitation Council.

A pilot multicentre study on 48 paramedic students performing patient assessment in pre-post cohorts (without and with the ABCDA CAT) was made in order to validate and evaluate the impact of the tool in simulated clinical scenarios.

The cumulative number and proper order of steps in clinical assessment in simulated scenarios were recorded and the time of the assessment was measured.

Results

The Delphi method resulted in the ABCDE CAT. The use of ABCDE CAT was associated with more performed assessment steps (804: 868; OR = 1.17, 95% CI: 1.02 to 1.35, p = 0.023) which were significantly more frequently performed in proper order (220: 338; OR = 1.68, 95% CI: 1.40 to 2.02, p < 0.0001). The use of ABCDE CAT did not prolong the time of patient assessment.

Conclusion

The cognitive aid for ABCDE assessment was developed. The use of this cognitive aid for ABCDE helps paramedics to perform more procedures, more frequently in the right order and did not prolong the patient assessment in advanced life support and peri-arrest care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12873-020-00390-3.

Impact of repeated simulation on learning curve characteristics of residents exposed to rare life threatening situations

Background

Little is known about the learning curve characteristics of residents undertaking simulation-based education. It is important to understand the time for acquisition and decay of knowledge and skills needed to manage rare and difficult clinical situations.

Method

Ten anaesthesiology residents underwent simulation-based education to manage a cannot intubate cannot ventilate scenario during general anaesthesia for caesarean section. Their performance was measured using an assessment tool and debriefed by two experienced anaesthesiologists. The parameters against which the performance was judged were grouped into preoperative assessment, preoperative patient care, equipment availability, induction sequence, communication and adherence to airway algorithm protocol. The scenario was repeated at 6 and 12 months thereafter. The residents’ acquisition of knowledge, technical and non-technical skills were assessed and compared at baseline, 6 months and end of 12 months.

Result

The skills of preoperative assessment, preoperative care and communication quickly improved but the specific skill of managing a difficult airway as measured by adherence to an airway algorithm required more than 6 months (CI at 6 vs 12 months: −3.4 to –0.81, p=0.016). The skills of preoperative assessment and preoperative care improved to a higher level quickly and were retained at this improved level. Communication (CI at 0 vs 6 months: −3.78 to −0.22, p=0.045 and at 6 vs 12 months : −3.39 to −1.49, p=0.007) and difficult airway management skill were slower to improve but continued to do so over the 12 months. The compliance to machine check was more gradual and showed an improvement at 12 months.

Conclusion

Our study is unique in analysing the learning curve characteristics of different components of a failed obstetric airway management skill. Repeated simulations over a longer period of time help in better reinforcement, retention of knowledge, recapitulation and implementation of technical and non-technical skills.

Aviation-Style Computerized Surgical Safety Checklist Displayed on a Large Screen and Operated by the Anesthesia Provider Improves Checklist Performance

BACKGROUND

Many hospitals have implemented surgical safety checklists based on the World Health Organization surgical safety checklist, which was associated with improved outcomes. However, the execution of the checklists is frequently incomplete. We reasoned that aviation-style computerized checklist displayed onto large, centrally located screen and operated by the anesthesia provider would improve the performance of surgical safety checklist.

METHODS

We performed a prospective before and after observational study to evaluate the effect of a computerized surgical safety checklist system on checklist performance. We created checklist software and translated our 4-part surgical safety checklist from wall poster into an aviation-style computerized format displayed onto a large, centrally located screen and operated by the anesthesia provider. Direct observers recorded performance of the first part of the surgical safety checklist that was initiated before anesthetic induction, including completion of each checklist item, provider participation and distraction level, resistance to use of the checklist, and the time required for checklist completion before and after checklist system implementation. We compared trends of the proportions of cases with 100% surgical safety checklist completion over time between pre- and postintervention periods and assessed for a jump at the start of intervention using segmented logistic regression model while controlling for potential confounding variables.

RESULTS

A total of 671 cases were observed before and 547 cases were observed after implementation of the computerized surgical safety checklist system. The proportion of cases in which all of the items of the surgical safety checklist were completed significantly increased from 2.1% to 86.3% after the computerized checklist system implementation (P < .001). Before computerized checklist system implementation, 488 of 671 (72.7%) cases had <75% of checklist items completed, whereas after a computerized checklist system implementation, only 3 of 547 (0.5%) cases had <75% of checklist items completed.

CONCLUSIONS

The implementation of a computerized surgical safety checklist system resulted in an improvement in checklist performance.

Anaesthesia-specific checklists: A systematic review of impact

Checklists are recognised as powerful tools to prevent avoidable errors in high-reliability organisations. In healthcare, the perioperative area has been a leading field in the development of a wide range of checklists. However, clinical literature on this subject is still sparse and heterogeneous, producing results that are sometimes conflicting. This systematic review assesses the current literature on perioperative routine and crisis checklists. Literature searches did not use a date limit and included articles up to March 2019. The methodological heterogeneity precluded combining data from the individual studies into a quantitative meta-analysis. Data are presented by means of a qualitative comparison with the reference groups based on a content analysis approach. Of the 874 identified articles, 25 were included in this review. Most identified studies (23, 92%) have shown that the use of checklists in anaesthesia can decrease human error, improve patient safety and teamwork, and increase quality of care. Beyond the WHO surgical time-out, anaesthesia-specific checklists have been shown to be useful for provider handoffs, emergencies, and routine anaesthesia procedures. However, literature on anaesthesia-specific checklists is still limited and very heterogeneous. More large-scale studies are necessary to identify an ideal anaesthesia checklist and its most appropriate implementation method.

The Current State of Perioperative Pain Management: Challenges and Potential Opportunities for Nurses

Achievement of adequate postoperative pain management is a critical challenge in health care, with an estimated three out of four adult surgical patients reporting moderate to extreme pain after surgery. Overreliance on opioids in acute care settings has persisted, despite well-known adverse side effects frequently associated with this class of drugs. Furthermore, patients with a history of chronic opioid use present additional challenges in terms of postsurgical pain management. Advances in the development of newer analgesic agents and anesthetic techniques may be useful in surgical patients with a history of chronic opioid use and in the overall surgical patient population. Systemic inefficiencies and problematic medical practice patterns can also have negative effects on perioperative pain management. As the surgical patient's primary advocate, perioperative nurses play an important role in overcoming these diverse challenges and addressing the problems associated with inadequately controlled postsurgical pain.

Attitudes of pediatric intensive care unit physicians towards the use of cognitive aids: a qualitative study

Background

Cognitive aids are increasingly recommended in clinical practice, yet little is known about the attitudes of physicians towards these tools.

Methods

We employed a qualitative, descriptive design to explore physician attitudes towards cognitive aids in pediatric intensive care units (PICUs). Semi-structured interviews elicited the opinions of a convenience sample of practicing PICU physicians towards the use of cognitive aids. We analyzed interview data for thematic content to examine the three factors of intention to use cognitive aids as defined by the Theory of Planned Behavior (TPB), attitudes, social norms, and perceived control.

Results

Analysis of 14 interviews suggested that in the PICU setting, cognitive aids are widely used. Discovered themes related to their use touched on all three TPB factors of intention and included: aids are perceived to improve team communication; aids may improve patient safety; aids may hinder clinician judgment; physicians may resist implementation if it occurs prior to demonstration of benefit; effective adoption requires cognitive aids to be integrated into local workplace culture; and implementation should take physician concerns into account.

Conclusions

Our sample of PICU physicians were open to cognitive aids in their practice, as long as such aids preserve the primacy of clinical judgment, focus on team communication, demonstrate effectiveness through preliminary testing, and are designed and implemented with the local culture and work environment in mind. Future knowledge translation efforts to implement cognitive aids would benefit from consideration of these issues.