Impact of drug and equipment preparation on pre-hospital emergency Anaesthesia (PHEA) procedural time, error rate and cognitive load

Abstract

BackgroundWe examined the effect of advanced preparation and organisation of equipment and drugs for Pre-hospital Emergency Anaesthesia (PHEA) and tracheal intubation on procedural time, error rates, and cognitive load.MethodsThis study was a randomised, controlled experiment with a crossover design. Clinical teams (physician and paramedic) from the Emergency Medical Retrieval Service and the Scottish Air Ambulance Division were randomised to perform a standardised pre-hospital clinical simulation using either unprepared (standard practice) or pre-prepared (experimental method) PHEA equipment and drugs. Following a two-week washout period, each team performed the corresponding simulation. The primary outcome was intervention time. Secondary outcomes were safety-related incidents and errors, and degree of cognitive load.ResultsIn total 23 experiments were completed, 12 using experimental method and 11 using standard practice. Time required to perform PHEA using the experimental method was significantly shorter than with standard practice (11,45 versus 20:59) minutes: seconds; p = < 0.001). The experimental method also significantly reduced procedural errors (0 versus 9, p = 0.007) and the cognitive load experienced by the intubator assistant (41.9 versus 68.7 mm, p = 0.006).ConclusionsPre-preparation of PHEA equipment and drugs resulted in safer performance of PHEA and has the potential to reduce on-scene time by up to a third.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0549-3) contains supplementary material, which is available to authorized users.

Optimising remote site airway management kit dump using the SCRAM bag—a randomised controlled trial

“…We believe that this reduces the number of decisions that must be made which leads to a significant reduction in set up time and error rate. It is interesting that the reduction in equipment kit dump time that we have observed in experienced anaesthetists was not observed when the SCRAM bag was used by paramedics (Swinton et al, 2018). This may reflect the differing controls that have been used between the two studies but may also represent a training gap in equipment preparation in anaesthetists compared with kit dump providers.…”

“…1) bag was initially designed for pre-hospital use and has an optimal ergonomic layout that includes a 'shadow template' cognitive aid. It is designed to provide a portable, structured and reproducible approach to preparing both drugs and equipment for advanced airway management (Swinton et al, 2018).…”

“…Many airway challenges experienced in the prehospital arena are similar to those experienced in remote hospital sites. Swinton et al (Swinton et al, 2018) investigated SCRAM bag use in experienced paramedics and demonstrated a significant reduction in drug, but not equipment, preparation time in addition to a reduction in the error rate in both phases. Pre-hospital providers are very familiar with rapid equipment preparation in the field.…”

Transfer of Pre-Hospital Care and Its Potential Risks for Patient Safety

“…4 The concern with the subject of patient safety in mobile emergency services is still emerging, although there is international literature, most involve actions directed to a professional category, and not to multidisciplinary work or between teams. [5][6] Reinforcing the existence of gaps in the knowledge about the theme, one study highlights the need for patient safety guidelines aimed specifically at emergency mobile prehospital care, as the unhealthy and hostile environment where the actions are carried out also requires specific guidance and several other health care services. 7 The international literature presents guidelines for the promotion of patient safety in various care environments.…”

Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review

“…The correct and timely use of facilities and equipment has been shown to improve patient safety, while any limitation in resources and facilities has been described as a barrier to the improvement of patient safety (58,59). Moreover, the use of cognitive aids and innovative assistant devices, such as preparation and monitoring systems that facilitate the flow of acute interventions in EDs, has been shown to help with reducing the rate of PSIs (60)(61)(62).…”