The Use of Cognitive Aids During Emergencies in Anesthesia

Marshall, Stuart

doi:10.1213/ane.0b013e31829c397b

Cited by 246 publications

(206 citation statements)

References 33 publications

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“…25 Cognitive aids, on the other hand, are external resources that can simplify the work process and help users complete a task by reducing extraneous cognitive load. [32][33][34] The CPI as a cognitive aid has the potential to benefit both patients and physicians. When the CPI is used, BForces you to seek objective data instead of perpetuating chart lore.…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

et al. 2016

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BACKGROUND: Patient history-taking is an essential clinical skill, with effects on diagnostic reasoning, patient-physician relationships, and more. We evaluated the impact of using a structured, timeline-based format, the Chronology of Present Illness (CPI), to guide the initial patient interaction. OBJECTIVE: To determine the feasibility and impact of the CPI on the patient interview, written notes, and communication with other providers. DESIGN: Internal medicine residents used the CPI during a 2-week night-float rotation. For the first week, residents interviewed, documented, and presented patient histories according to their normal practices. They then attended a brief educational session describing the CPI, and were asked to use this method for new patient interviews, notes, and handoffs during the second week. Night and day teams evaluated the method using retrospective prepost comparisons. PARTICIPANTS: Twenty-two internal medicine residents in their second or third postgraduate year. INTERVENTION: An educational dinner describing the format and potential benefits of using the CPI. MAIN MEASURES: Retrospective pre-post surveys on the efficiency, quality, and clarity of the patient interaction, written note, and verbal handoff, as well as open-ended comments. Respondents included night-float residents, day team residents, and attending physicians. KEY RESULTS: All night-float residents responded, reporting significant improvements in written note, verbal sign-out, assessment and plan, patient interaction, and overall efficiency (p < 0.05). Day team residents (n = 76) also reported increased clarity in verbal sign-out and written note, improved efficiency, and improved preparedness for presenting the patient (p < 0.05). Attending physician ratings did not differ between groups. CONCLUSIONS: Resident ratings indicate that the CPI can improve key aspects of patient care, including the patient interview, note, and physician-physician communication. These results suggest that the method should be taught and implemented more frequently.

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Section: Discussionmentioning

confidence: 99%

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

et al. 2016

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“…87 In Paper 1, I provide a detailed evaluation of the ILCOR algorithm and four variations by member councils against CMAT design criteria, 57 and against medical device guidelines. 33 The outcome of this study was that the ILCOR algorithm had moderate adherence to both CMAT criteria and the medical device guidelines, but that design variations reduced the adherence to these guidelines.…”

Section: Phase 1 Current Team Training and Interventions: Crm And Comentioning

confidence: 91%

“…33 34 35 Cognitive aids can take the form of checklists, visual displays, auditory displays, decision support tools, mnemonics, or any other artefact that supports cognitive processes such as attention and working memory. 33 Cognition extends beyond the internal processing of the individual. Cognition is shared (distributed) between (1) the team, (2) their equipment, and (3) their environment.…”

Section: Cognition and Cognitive Aidsmentioning

confidence: 99%

“…The evidence suggests that cognitive aids can improve team performance of clinical tasks, 41 but they can also improve team behaviors. 33 However, there is a danger that poorly designed aids can lead to clinical errors and breakdown in team communication. 33 These findings highlight the need for an empirical design process in healthcare equipment generally, 86 and cognitive aids specifically.…”

Section: Phase 1 Current Team Training and Interventions: Crm And Comentioning

confidence: 99%

“…59 Cognitive aids can support attention and working memory, thereby reducing cognitive load and improve situation awareness. 33 However, cognition extends beyond the individual-it is distributed between the team, the task, their equipment, and the environment. 36 88 Therefore, cognitive aids should be designed to support the entire cognitive system.…”

Section: Phase 1 Current Team Training and Interventions: Crm And Comentioning

confidence: 99%

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Developing the NeoReadyTM: a systems approach to supporting teams during neonatal resuscitation

McLanders¹

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The purpose of this program of research was to improve teamwork during neonatal resuscitation. As in other areas of healthcare, Crisis Resource Management (CRM)-the aviation-derived teamwork model-has been incorporated into neonatal resuscitation training programs. Although there is evidence that CRM training improves teamwork during neonatal resuscitation, there are weak and inconsistent correlations between the CRM principles and teamwork behaviour. In this thesis, I argue that teamwork interventions need to be developed in context of the broader work system, and I also argue that interventions in the form of functional or cognitive aids should incorporate the science of design. Employing a user-centred design approach, I developed an intervention that is specific to the requirements of neonatal resuscitation teams-which comprises a 4-part cognitive system aid (the NeoReady TM ).In the first phase of this program of research, I reviewed the effectiveness of neonatal resuscitation teamwork training interventions to date. An analysis of the differences between aviation crews and neonatal resuscitation teams provided insight into why CRM needs to be adapted to fit the needs of the team and their environment. One example of where CRM has been adapted to suit the requirements of the domain can be seen in anaesthesia. The CRM model used in anaesthesia and other domains advocates the use of cognitive aids. I investigated the evidence supporting the use of cognitive aids, and examined how they are used in neonatal resuscitation. Although there is evidence that cognitive aids can support individuals and teams, poor design of cognitive aids can lead to unintended and adverse consequences. Moreover, cognitive aids often only support individual cognition, whereas they can be used to support the broader cognitive system, including the environment. The first phase of research concluded with an evaluation of the neonatal resuscitation decision algorithm according to human factors design principles.In the second phase of this program of research, I conducted a team task analysis based on the main steps of resuscitation as outlined in the neonatal resuscitation algorithm. The task analysis revealed some of the areas that are most vulnerable to breakdown in team coordination. I presented general classes of potential solutions. Using an existing database of video recordings of neonatal resuscitations, I illustrated that team coordination can affect patient outcomes-specifically that the transition between ceasing ventilation and commencing intubation could be improved by better team coordination.Another key contribution of this study was that it provided compelling evidence that the iii measure for intubation expertise should not be psychomotor performance, but rather how the intubation attempt affects the patient. These findings provide tangible evidence for the need to improve team coordination so to improve patient outcomes.In the third and final phase of this program of research, I describe the process of developing ...

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Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

et al. 2020

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IMPORTANCE Failure to rescue causes significant morbidity and mortality in the surgical population. Human error is often the underlying cause of failure to rescue. Human error can be reduced by the use of cognitive aids.OBJECTIVES To test the effectiveness of cognitive aids on adherence to best practice in the management of deteriorating postoperative surgical ward patients. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial in a simulation setting. Surgical teams consisted of 1 surgeon and 2 nurses from a surgical ward from 4 different hospitals in Amsterdam, the Netherlands. Data were analyzed between February 2, 2017, and December 18, 2018.INTERVENTIONS The teams were randomized to manage 3 simulated deteriorating patient scenarios with or without the use of cognitive aids. MAIN OUTCOMES AND MEASURESThe primary outcome of the study was failure to adhere to best practice, expressed as the percentage of omitted critical management steps. The secondary outcome of the study was the perceived usability of the cognitive aids. RESULTSOf the total participants, 93 were women and 51 were men. Twenty-five surgical teams performed 75 patient scenarios with cognitive aids, and 25 teams performed 75 patient scenarios without cognitive aids. Using the cognitive aids resulted in a reduction of omitted critical management steps from 33% to 10%, which is a 70% (P < .001) reduction. This effect remained significant (odds ratio, 0.63; 95% CI, −0.228 to −0.061; P = .001) in a multivariate analysis. Overall usability (scale of 0-10) of the cognitive aids was scored at a median of 8.7 (interquartile range, 8-9). CONCLUSIONS AND RELEVANCEFailure to comply with best practice management of postoperative complications is associated with worse outcomes. In this simulation study, adherence to best practice in the management of postoperative complications improves significantly by the use of cognitive aids. Cognitive aids for deteriorating surgical patients therefore have the potential to reduce failure to rescue and improve patient outcome.

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The Use of Cognitive Aids During Emergencies in Anesthesia

Cited by 246 publications

References 33 publications

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

A Pilot Study of the Chronology of Present Illness: Restructuring the HPI to Improve Physician Cognition and Communication

Developing the NeoReadyTM: a systems approach to supporting teams during neonatal resuscitation

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

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