Emergency Manuals Improved Novice Physician Performance During Simulated ICU Emergencies

Abstract

Background Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU). Methods PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant. ResultsThe participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group. ConclusionsThe use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase). BackgroundEvery year a changeover of trainees occurs in teaching hospitals where novice physicians (PGY1), or interns, take on new responsibilities while simultaneously facing the stressors encountered at the beginning of residency.Consequently, evidence suggests that mortality increases and efficiency decreases in hospitals in the first month after year-end changeovers 1 . Reasons may include the loss of experienced staff, relative inexperience of each new group moving up in rank (e.g. new interns, new senior residents, and new supervisor physicians), and a general lack of institutional and tacit knowledge (e.g. new teams, figuring out "how we do things here"). In the context of these safety vulnerabilities, novice physicians may find themselves with the responsibility of managing acute lifethreatening events in various clinical settings 2,3 . Caring for