The Effect of an Electronic Dynamic Cognitive Aid Versus a Static Cognitive Aid on the Management of a Simulated Crisis: A Randomized Controlled Trial
- 53 Downloads
The aim of this study was to assess the effect of a dynamic electronic cognitive aid with embedded clinical decision support (dCA) versus a static cognitive aid (sCA) tool. Anesthesia residents in clinical anesthesia years 2 and 3 were recruited to participate. Each subject was randomized to one of two groups and performed an identical simulated clinical scenario. The primary outcome was task checklist performance with a secondary outcome of performance using the Anesthesia Non-technical skills (ANTS) scoring system. 34 residents were recruited to participate in the study. 19 residents were randomized to the sCA group and 15 to the dCA group. Overall inter-rater agreement for total checklist, malignant hyperthermia, hyperkalemia and ventricular fibrillation was 98.9%, 97.8%, 99.5% and 99.5% respectively with similar Kappa coefficient. Inter-rater agreement for ANTS partial ratings, however, was only 53.5% with a similar Kappa of 0.15. Mean performance was statistically higher in the dCA group versus the sCA group for total check list performance (15.70 ± 1.93 vs 12.95 ± 2.16, p < 0.0001). The difference in performance between dCA and sCA is most notable in dose-dependent related checklist items (4.60 ± 1.3 vs 1.89 ± 1.23, p < 0.0001), while the performance score for dose-independent checklist items was similar between the two groups (p = 0.8908). ANTS ratings did not differ between groups. In conclusion, we evaluated the use of a sCA versus a dCA with embedded decision support in a simulated environment. The dCA group was found to perform more checklist items correctly.
Clinical Trial Registration: Clinicaltrials.gov study #: NCT02440607.
KeywordsSimulation Cognitive aid Crisis management
Special thanks to the staff of the Grainger Center for Simulation and Innovation. NorthShore University HealthSystem.
Compliance with Ethical Standards
Sources of Financial Support
Support was provided from institutional and/or departmental sources and a grant from the Women’s Auxillary Board, NorthShore University HealthSystem.
Conflict of Interest
The authors declare no competing interests.
- 6.Watkins, S. C., Anders, S., Clebone, A., Hughes, E., Patel, V., Zeigler, L., Shi, Y., Shotwell, M. S., McEvoy, M. D., and Weinger, M. B., Mode of information delivery does not effect anesthesia trainee performance during simulated perioperative pediatric critical events: A trial of paper versus electronic cognitive aids. Simul. Healthc. 11:385–393, 2016.CrossRefGoogle Scholar
- 8.Neumar, R. W., Shuster, M., Callaway, C., and Gent, L., 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 132(18):Supp 2, 2015.Google Scholar
- 10.Bruppacher, H. R., Alam, S. K., LeBlanc, V. R., Latter, D., Naik, V. N., Savoldelli, G. L., Mazer, C. D., Kurrek, M. M., and Joo, H. S., Simulation-based training improves physicians' performance in patient care in high-stakes clinical setting of cardiac surgery. Anesthesiology 112:985–992, 2010.CrossRefGoogle Scholar
- 14.Shear, T., Deshur, M., Avram, M. J., Greenberg, S. B., Murphy, G. S., Ujiki, M., Szokol, J. W., Vender, J. S., Patel, A., and Wijas, B., Procedural timeout compliance is improved with real-time clinical decision support. J. Patient Saf. 1, 2015. https://doi.org/10.1097/PTS.0000000000000185.