Dataset Information

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients: A Randomized Clinical Trial in a Simulation Setting.

ABSTRACT:

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 measures

The 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.

Results

Of 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 relevance

Failure 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.

Trial registration

ClinicalTrials.gov identifier: NCT03812861.

SUBMITTER: Koers L

PROVIDER: S-EPMC6902237 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients: A Randomized Clinical Trial in a Simulation Setting.

Koers Lena L van Haperen Maartje M Meijer Clemens G F CGF van Wandelen Suzanne B E SBE Waller Elbert E Dongelmans Dave D Boermeester Marja A MA Hermanides Jeroen J Preckel Benedikt B

JAMA surgery 20200115 1

<h4>Importance</h4>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.<h4>Objectives</h4>To test the effectiveness of cognitive aids on adherence to best practice in the management of deteriorating postoperative surgical ward patients.<h4>Design, setting, and participants</h4>Randomized clinical trial in a simulation setting. Surgical teams ...[more]

PMID: 31774483

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Project description:BackgroundMedical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated medical emergencies by experienced teams. In this randomized trial we evaluated guideline adherence and treatment efficacy in simulated medical emergencies managed by residents with and without CA.MethodsPhysicians attending educational courses executed simulated medical emergencies. Teams were randomly assigned to manage emergencies with or without CA. Primary outcome was risk reduction of essential working steps. Secondary outcomes included prior experience in emergency medicine and CA, perceptions of usefulness, clinical relevance, acceptability, and accuracy in CA selection. Participants were grouped as "medical" (internal medicine and neurology) and "perioperative" (anesthesia and surgery) regarding their specialty. The study was designed as a prospective randomized single-blind study that was approved by the ethical committee of the University Duisburg-Essen (19-8966-BO).Trial registrationDRKS, DRKS00024781. Registered 16 March 2021-Retrospectively registered, http://www.drks.de/DRKS00024781 .ResultsEighty teams participated in 240 simulated medical emergencies. Cognitive aid usage led to 9% absolute and 15% relative risk reduction. Per protocol analysis showed 17% absolute and 28% relative risk reduction. Wrong CA were used in 4%. Cognitive aids were judged as helpful by 94% of the participants. Teams performed significantly better when emergency CA were available (p < 0.05 for successful completion of critical work steps). Stress reduction using CA was more likely in "medical" than in "perioperative" subspecialties (3.7 ± 1.2 vs. 2.9 ± 1.2, p < 0.05).ConclusionsIn a high-fidelity simulation study, CA usage was associated with significant reduction of incorrect working steps in medical emergencies management and was characterized by high acceptance. These findings suggest that CA for medical emergencies may have the potential to improve emergency care.

Project description:Background: Stress and human error during perioperative emergency situations can significantly impact patient morbidity and mortality. Previous research has shown that cognitive aid bundles (CABs) minimize critical misses by 75%. This study aimed to compare the effectiveness of two different CAB designs with the same content in reducing missed critical management steps for simulated perioperative emergencies. Methods: A multicenter randomized controlled simulation-based study was conducted including 27 teams, each consisting of three participants; each team performed four simulation scenarios. In the first scenario for each team (Scenario 1), no CAB was used. Scenarios 2 and 3 were randomly allocated to the groups, with either a branched, clustered design (CAB-1) or a linear, step-by-step design (CAB-2) of the cognitive aid. In Scenario 4, the groups used one of the previously mentioned CABs according to their own preference. The primary outcome was the difference in the percentage of missed critical management steps between the two different CABs. Secondary outcomes included user preference for one CAB design and the reduction in percentage of missed critical management steps using any CAB versus no CAB. Results: Twenty-seven teams simulated 108 perioperative emergency situations. The percentage of missed critical management steps was similar between CAB-1 and CAB-2 (27% [interquartile range (IQR) 20-29] versus 29% [IQR 20-35], p = 0.23). However, most participants favored the branched, clustered design CAB-1 (77.8%). Additionally, employing any CAB reduced the percentage of missed critical management steps by 36% (33% missed steps vs. 21% missed steps, p = 0.003). Conclusions: While the two CAB designs did not differ significantly in reducing missed critical management steps, the branched, clustered design was perceived as more user-friendly. Importantly, using any CAB significantly reduced the percentage of missed critical management steps compared to not using a cognitive aid, emphasizing the need for CAB use in the operating room.

Dataset Information

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients: A Randomized Clinical Trial in a Simulation Setting.

Importance

Objectives

Design, setting, and participants

Interventions

Main outcomes and measures

Results

Conclusions and relevance

Trial registration

Publications

Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients: A Randomized Clinical Trial in a Simulation Setting.

Similar Datasets

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