Compairing two cognitive aids

In the Netherlands, two University Hospitals have developed a hospital specific version of an emergency manual. These emergency manuals are care-bundles of Cognitive Aids that help care providers to perform and speed up all the critical steps to be taken in an emergency situation.

The evidence of using a Cognitive Aid in emergencies is not yet conclusive. This lack of evidence, however, is caused by the limited research that has been performed and the deficiencies in design and evaluation of currently used cognitive aids.2,3,4

Therefore we want to compare two different emergency manuals used in critical anesthetic situations. One of these bundles was developed in 2014 by the department of anesthesiology of the Amsterdam UMC. It is based on the emergency manual from Stanford Anesthesia Cognitive Aids group and national and institutional guidelines. The second emergency manual is developed by the department of anesthesiology of the UMC Utrecht in 2016. Its content is based on the emergency manual from Stanford Anesthesia Cognitive Aid group and the layout is based on emergency checklists of the Dutch Royal Air force.

During the first phase, 24 volunteers – anesthesiologists, unfamiliar with one or both of the emergency manuals - receive a questionnaire based on the content of both emergency manuals. The questionnaire will contain 25 questions on critical steps during anesthetic emergencies. The answers can be found in the manuals.
After writing down their initial choice for one of the two bundles, the volunteers are divided in two groups either to use bundle A or B to answer the questionnaire. Time necessary to answer the questions of manual A or B will be taken and reported.

In phase two, 24 voluntary teams consisting of a consultant anesthesiologist and anesthetic nurse with a third medical professional, unfamiliar with both emergency manuals in their daily practice, will be observed during a simulated critical anesthetic situation on their response. The scenarios will be performed on site in their regular environment. Five different scenarios will be used, two resuscitation scenario's (PEA, VF) and 3 other anesthetic emergencies ( masive bleeding, anafylaxis, severe bronchospasm. Anesthesiologists in The Netherlands are used to this training modality, as it is a mandatory part of the residency programmes.

All voluntary teams will get 4 standardized simulation scenarios. For the first scenario they don't use an emergency manualare and are randomized on which resuscitation scenario they start with. After the first scenario the teams will answer a questionair on their situational awareness. The second scenario the teams are randomized to start with on of the two emergency manuals and on the scenario's. The third scenario they will automatically use the other emergency manual and are the teams randomized between the two remaining scenario's. At last for the fourth scenario the other resuscitation scenario is being used and the teams have to choose which emergency manual they will use. After the last scenario again the teams have to fill in the situational awareness questionaire.

Which design of cognitive aid (emergency manual) is easier to use and results in less missed critical actions during anesthetic emergencies

stop inclusion oktober 2020

use of different emergency manuals