Advanced closed-loop communication training: the blindfolded resuscitation

Abstract

<jats:p>Closed-loop communication (CLC) improves task efficiency and decreases medical errors; however, limited literature on strategies to improve real-time use exist. The primary objective was whether blindfolding a resuscitation leader was effective to improve crisis resource management (CRM) skills, as measured by increased frequency of CLC. Secondary objectives included whether blindfolding affected overall CRM performance or perceived task load. Participants included emergency medicine (EM) or EM/paediatric dual resident physicians. Participants completed presurveys, were block randomised into intervention (blindfolded) or control groups, lead both adult and paediatric resuscitations and completed postsurveys before debriefing. Video recordings of the simulations were reviewed by simulation fellowship-trained EM physicians and rated using the Ottawa CRM Global Rating Scale (GRS). Frequency of CLC was assessed by one rater via video review. Summary statistics were performed. Intraclass correlation coefficient was calculated. Data were analysed using R program for analysis of variance and regression analysis. There were no significant differences between intervention and control groups in any Ottawa CRM GRS category. Postgraduate year (PGY) significantly impacts all Ottawa GRS categories. Frequency of CLC use significantly increased in the blindfolded group (31.7, 95% CI 29.34 to 34.1) vs the non-blindfolded group (24.6, 95% CI 21.5 to 27.7). Participant’s self-rated perceived NASA Task Load Index scores demonstrated no difference between intervention and control groups via a Wilcoxon rank sum test. Blindfolding the resuscitation leader significantly increases frequency of CLC. The blindfold code training exercise is an advanced technique that may increase the use of CLC.</jats:p>

A potentially lifesaving error: unintentional high-dose adrenaline administration in anaphylaxis-induced cardiac arrest; a case report

“…Firstly, the management of anaphylaxis is often characterized by inappropriate dosing and timing of epinephrine as a first-line medication [ 4 , 9 , 10 ]. This might indicate a need for high-fidelity simulation and training for anaphylaxis and CPR in special circumstances [ 2 , 32 ] and for organizational measures like standardization of code medications and prefilled or pre-labelled syringes [ 8 , 33 ]. Second, crew resource management elements (e.g.…”

“…Second, crew resource management elements (e.g. closed-loop communication, read-backs, call-outs) [ 32 , 33 ] should be a bedrock component in professional development for all healthcare workers. Additionally, these measures must be embedded in error-preventing environments on organizational levels [ 16 , 34 ].…”