“Helper:” A critical events prompter for unexpected emergencies

Schneider, Arthur J.L.; Murray, W. Bosseau; Mentzer, Steven; Miranda, Francisco Arnoldo Nunes de; Vaduva, Sorin

doi:10.1007/bf01616741

Cited by 24 publications

(19 citation statements)

References 8 publications

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“…Two of the remaining 3 studies showed no improvement in neonatal (Bould et al 40 ) and adult (Schneider et al 32 ) resuscitation. Two of the remaining 3 studies showed no improvement in neonatal (Bould et al 40 ) and adult (Schneider et al 32 ) resuscitation.…”

Section: Evaluation Of the Aidmentioning

confidence: 99%

“…The content of 13 cognitive aids was derived from existing national guidelines 18,19,26,29,30,[32][33][34][35][36][37]40,42 including all of the aids relating to management of cardiac arrest of adults [32][33][34][35][36][37] and neonates. 40 This may reflect the existence of established national and international guidelines for cardiopulmonary resuscitation.…”

Section: Content Of the Cognitive Aidmentioning

confidence: 99%

“…18,[25][26][27]32,33,36,37 In 3 of the remaining 15 studies, the cognitive aid was deliberately not shown to participants before they used it, but participants were informed that a cognitive aid would be present. 18,[25][26][27]32,33,36,37 In 3 of the remaining 15 studies, the cognitive aid was deliberately not shown to participants before they used it, but participants were informed that a cognitive aid would be present.…”

Section: Training In the Use Of The Cognitive Aidmentioning

confidence: 99%

“…18,[25][26][27]32,33,36,37 In 3 of the remaining 15 studies, the cognitive aid was deliberately not shown to participants before they used it, but participants were informed that a cognitive aid would be present. 26,32 Effects on Team Functioning Only 4 aids have been evaluated with regard to their effects on team functioning beyond the ability to merely perform tasks accurately and efficiently. In 2 studies that found no difference in performance while using a cognitive aid, participants were allowed to familiarize themselves with the aid before using it.…”

Section: Training In the Use Of The Cognitive Aidmentioning

confidence: 99%

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The Use of Cognitive Aids During Emergencies in Anesthesia

Marshall

2013

Anesthesia &Amp; Analgesia

246

179

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Cognitive aids are prompts designed to help users complete a task or series of tasks. They may take the form of posters, flowcharts, checklists, or even mnemonics. It has been suggested that the use of cognitive aids improves performance and patient outcomes during anesthetic emergencies; however, a systematic assessment of the evidence is lacking. The aim of this literature review was to determine (1) whether cognitive aids improve performance of individuals and teams and (2) whether recommendations can be made for future cognitive aid design, testing, and implementation. Medical, nursing, and psychology databases were searched using broad criteria to find cognitive aids that have been reported in the literature for use in anesthetic emergencies. The reference lists of the articles selected for review were also screened to identify additional studies. Selected articles that described the evaluation of cognitive aids used in anesthetic emergencies were reviewed to determine how the content of the aid was derived, how the design was evaluated, and the success of the aid in improving technical and team performance. The search yielded 22 cognitive aids developed to support clinicians during anesthetic emergencies that had been evaluated in 23 studies. Ten studies using simulation suggested that technical performance improves with the use of cognitive aids in some anesthetic emergencies such as malignant hyperthermia, cardiopulmonary resuscitation, and airway management. However, in 3 of the simulator-based evaluations, participants had either no improvement or took longer to diagnose and treat and made more incorrect diagnoses. Four studies investigated the effect of the aids on teamwork with differing conclusions. One study suggested improved participants' coordination patterns and one found aids improved their decision-making scores, but 2 other studies indicated that there was no improvement and even provided evidence of reduced levels of team communication when teams used a cognitive aid in simulated conditions. The designs of cognitive aids were rarely considered. Education may compensate for a poorly designed aid, but only by ingraining correct actions for situations in which the aid provides little or no guidance. Cognitive aids should continue to be developed from established clinical guidelines where guidelines exist. They would also benefit from more extensive simulation-based usability testing before use. Further evidence is required to explore the effects of cognitive aids in anesthetic emergencies, how they affect team function, and their design considerations.

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Section: Evaluation Of the Aidmentioning

confidence: 99%

Section: Content Of the Cognitive Aidmentioning

confidence: 99%

Section: Training In the Use Of The Cognitive Aidmentioning

confidence: 99%

“…18,[25][26][27]32,33,36,37 In 3 of the remaining 15 studies, the cognitive aid was deliberately not shown to participants before they used it, but participants were informed that a cognitive aid would be present. 26,32 Effects on Team Functioning Only 4 aids have been evaluated with regard to their effects on team functioning beyond the ability to merely perform tasks accurately and efficiently. In 2 studies that found no difference in performance while using a cognitive aid, participants were allowed to familiarize themselves with the aid before using it.…”

Section: Training In the Use Of The Cognitive Aidmentioning

confidence: 99%

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The Use of Cognitive Aids During Emergencies in Anesthesia

Marshall

2013

Anesthesia &Amp; Analgesia

246

179

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“…Simulation studies of basic life support, 186 -190 advanced life support, 191,192 and anesthetic emergencies 193,194 demonstrated improved performance when checklists or cognitive aids were used. However, 1 simulation study demonstrated delayed completion of 2 cycles of CPR 195 when individuals not adept at cell phone operation used a cell phone-based cognitive aid.…”

Section: Improving Resuscitation Skills Checklists/cognitive Aidsmentioning

confidence: 99%

Part 16: Education, Implementation, and Teams

Bhanji¹,

Mancini²,

et al. 2010

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C ardiac arrest occurs in a wide variety of settings, from the unanticipated event in the out-of-hospital setting to anticipated arrests in the intensive care unit. Outcome from cardiac arrest is a function of many factors including the willingness of bystanders to perform cardiopulmonary resuscitation (CPR), the ability of rescuers to integrate knowledge and psychomotor skills, the quality of performance delivered by individual rescuers and teams, and the efficiency and effectiveness of post-cardiac arrest care.The Chain of Survival is a metaphor used to organize and describe the integrated set of time-sensitive, coordinated actions necessary to maximize survival from cardiac arrest. The use of evidence-based education and implementation strategies can optimize the links of that chain.Strengthening the Chain of Survival in the prehospital setting requires focus on prevention and immediate recognition of cardiac arrest, increasing the likelihood of high-quality bystander CPR and early defibrillation, and improving regional systems of care. In the hospital setting, organized efforts targeting early identification and prevention of deterioration in patients at risk can decrease the incidence of cardiac arrest. The challenge for resuscitation programs is twofold: to ensure that providers acquire and maintain the necessary knowledge, skills, and team behavior to maximize resuscitation outcome; and to assist response systems in developing, implementing, and sustaining an evidence-based Chain of Survival.Maximizing survival from cardiac arrest requires improvement in resuscitation education and the implementation of systems that support the delivery of high-quality resuscitation and postarrest care, including mechanisms to systematically evaluate resuscitation performance. Well-designed resuscitation education can encourage the delivery of high-quality CPR. In addition continuous quality improvement processes should close the feedback loop and narrow the gap between ideal and actual performance. Community-and hospitalbased resuscitation programs should systematically monitor cardiac arrests, the level of resuscitation care provided, and outcomes. The cycle of measurement, benchmarking, feedback, and change provides fundamental information necessary to optimize resuscitation care and maximize survival.This chapter reviews key educational issues that affect the quality of resuscitation performance and describes major implementation and team-related issues shown to improve outcomes. The information is organized into four major categories: willingness to perform CPR, educational design, improving resuscitation quality, and issues related to implementation and outcomes.While Willingness to PerformWithout immediate initiation of CPR, most victims of cardiac arrest will die. Bystander CPR can significantly improve survival rates from cardiac arrest, 3 but recent evidence indicates that only 15% to 30% of victims of out-of-hospital arrest receive CPR before EMS arrival. 4 Strategies to increase the incidence of bystander-ini...

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Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest

Corazza,

Arpone,

Tardini

et al. 2023

JAMA Netw Open

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ImportanceDeviations from international resuscitation guidelines during the management of pediatric cardiac arrest are frequent and affect clinical outcomes. An interactive tablet application (app), PediAppRREST, was developed to reduce guideline deviations during pediatric cardiac arrest.ObjectiveTo assess the effectiveness of PediAppRREST in improving the management of simulated in-hospital pediatric cardiac arrest.Design, Setting, and ParticipantsThis multicenter 3-group simulation-based randomized clinical trial was conducted from September 2020 to December 2021 at 4 Italian university hospitals (Padua, Florence, Rome, Novara). Participants included residents in pediatrics, emergency medicine, and anesthesiology. Analyses were conducted as intention-to-treat. Data were analyzed from January to June 2022.InterventionsTeams were randomized to 1 of 3 study groups: an intervention group that used the PediAppRREST app; a control group that used a paper-based cognitive aid, the Pediatric Advanced Life Support (PALS) pocket card; and a control group that used no cognitive aids. All the teams managed the same standardized simulated scenario of nonshockable pediatric cardiac arrest.Main Outcomes and MeasuresThe primary outcome was the number of deviations from guidelines, measured by a 15-item checklist based on guideline recommendations. The main secondary outcomes were quality of chest compressions, team clinical performance (measured by the Clinical Performance Tool), and perceived team leader’s workload. Study outcomes were assessed via video reviews of the scenarios.ResultsOverall 100 teams of 300 participants (mean [SD] age, 29.0 [2.2] years; 195 [65%] female) were analyzed by intention-to-treat, including 32 teams randomized to the PediAppRREST group, 35 teams randomized to the PALS control group, and 33 teams randomized to the null control group. Participant characteristics (210 pediatric residents [70%]; 48 anesthesiology residents [16%]; 42 emergency medicine residents [14%]) were not statistically different among the study groups. The number of deviations from guidelines was significantly lower in the PediAppRREST group than in the control groups (mean difference vs PALS control, −3.0; 95% CI, −4.0 to −1.9; P &lt; .001; mean difference vs null control, −2.6; 95% CI, −3.6 to −1.5; P &lt; .001). Clinical Performance Tool scores were significantly higher in the PediAppRREST group than control groups (mean difference vs PALS control, 1.4; 95% CI, 0.4 to 2.3; P = .002; mean difference vs null control, 1.1; 95% CI, 0.2 to 2.1; P = .01). The other secondary outcomes did not significantly differ among the study groups.Conclusions and RelevanceIn this randomized clinical trial, the use of the PediAppRREST app resulted in fewer deviations from guidelines and a better team clinical performance during the management of pediatric cardiac arrest.Trial RegistrationClinicalTrials.gov Identifier: NCT04619498

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“Helper:” A critical events prompter for unexpected emergencies

Abstract: These data demonstrate the value of a prompting device at the anesthesia workstation. We foresee the use of such prompters in many areas of medicine.

Cited by 24 publications

References 8 publications

The Use of Cognitive Aids During Emergencies in Anesthesia

The Use of Cognitive Aids During Emergencies in Anesthesia

Part 16: Education, Implementation, and Teams

Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest

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