Do cognitive aids reduce error rates in resuscitation team performance? Trial of emergency medicine protocols in simulation training (TEMPIST) in Australia

Abstract

Background: Resuscitation of patients with time-critical and life-threatening illness represents a cognitive challenge for emergency room (ER) clinicians. We designed a cognitive aid, the Emergency Protocols Handbook, to simplify clinical management and team processes. Resuscitation guidelines were reformatted into simple, single step-bystep pathways. This Australian randomised controlled trial tested the effectiveness of this cognitive aid in a simulated ER environment by observing team error rates when current resuscitation guidelines were followed, with and without the handbook. Methods: Resuscitation teams were randomised to manage two scenarios with the handbook and two without in a high-fidelity simulation centre. Each scenario was video-recorded. The primary outcome measure was error rates (the number of errors made out of 15 key tasks per scenario). Key tasks varied by scenario. Each team completed four scenarios and was measured on 60 key tasks. Participants were surveyed regarding their perception of the usefulness of the handbook. Results: Twenty-one groups performed 84 ER crisis simulations. The unadjusted error rate in the handbook group was 18.8% (121/645) versus 38.9% (239/615) in the non-handbook group. There was a statistically significant reduction of 54.0% (95% CI 49.9-57.9) in the estimated percentage error rate when the handbook was available across all scenarios 17.9% (95% CI 14.4-22.0%) versus 38.9% (95% CI 34.2-43.9%). Almost all (97%) participants said they would want to use this cognitive aid during a real medical crisis situation. Conclusion: This trial showed that by following the step-by-step, linear pathways in the handbook, clinicians more than halved their teams' rate of error, across four simulated medical crises. The handbook improves team performance and enables healthcare teams to reduce clinical error rates and thus reduce harm for patients.

“We are left with nothing to work with”; challenges of nurses working in the emergency unit at a secondary referral hospital: A descriptive qualitative study

“…The World Health Report in 2006 classified Ghana among 36 countries in SSA facing a health workforce crisis [ 36 ] which necessitated government interventions through the Ministry of Health to address a myriad health workforce challenges. Recently out of about 115 650 employed public sector health workers, 58% were nurses and midwives in Ghana [ 37 , 38 ]. From 2008 to 2018, there has been a remarkable increase in the nursing workforce of about 370% [ 37 ].…”

“…From 2008 to 2018, there has been a remarkable increase in the nursing workforce of about 370% [ 37 ]. Nonetheless, empirically, there exists a persistent shortage of nurses and midwives in most hospitals and clinics across Ghana [ 37 , 38 ]. As in recent times over 40,000 trained nurses and midwives have been unemployed between 2016 to 2019 whiles health facilities across the country are in dire need of these professionals.…”

“…As in recent times over 40,000 trained nurses and midwives have been unemployed between 2016 to 2019 whiles health facilities across the country are in dire need of these professionals. Due to the extended credit facility agreement between the government of Ghana and the International Monetary Fund with its associated austerity measures, most of the graduated nurses from 2016 and 2018 could not be immediately employed [ 38 ].…”

Social Support Mediates the Effect of Burnout on Health in Health Care Professionals

“…Although burnout may occur in any job context, it is most notable among health care professionals where, for example, burnout can impact as many as half of all physicians ( Gandi et al, 2011 ; Ebling and Carlotto, 2012 ; Koutsimani et al, 2019 ; Dall’Ora et al, 2020 ). This high prevalence is relevant because approximately 50% of medical leaves are due to burnout ( Demerouti et al, 2002 ).…”

Development and Assessment of the Personal Emotional Capital Questionnaire for Adults

“…Social capital reduces job burnout and emotional capital plays a crucial role in improving relationships and increasing social capital. In healthcare, teamwork is critical and the need for emotional capital is essential for nurses [ 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”