Simulation-based randomized trial of medical emergency cognitive aids

Timur Sellmann; Samer Alchab; Dietmar Wetzchewald; Joerg Meyer; Tienush Rassaf; Serge C Thal; Christian Burisch; Stephan Marsch; Frank Breuckmann

doi:10.1186/s13049-022-01028-y

Simulation-based randomized trial of medical emergency cognitive aids

Scand J Trauma Resusc Emerg Med. 2022 Jul 11;30(1):45. doi: 10.1186/s13049-022-01028-y.

Authors

Timur Sellmann^{1

2}, Samer Alchab³, Dietmar Wetzchewald⁴, Joerg Meyer⁵, Tienush Rassaf⁶, Serge C Thal⁷, Christian Burisch⁸, Stephan Marsch⁹, Frank Breuckmann^{3

4

6}

Affiliations

¹ Department of Anaesthesiology and Intensive Care Medicine, Bethesda Hospital, Heerstrasse 219, 47053, Duisburg, Germany. t.sellmann@bethesda.de.
² Department of Anaesthesiology I, Witten-Herdecke University, Witten, Germany. t.sellmann@bethesda.de.
³ Department of Internal Medicine 1, Herz-Jesu-Hospital Dernbach, Dernbach, Germany.
⁴ Institution for Emergency Medicine, Arnsberg, Germany.
⁵ Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, St. Marien-Hospital, Muelheim an der Ruhr, Germany.
⁶ Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.
⁷ Department of Anaesthesiology I, Witten-Herdecke University, Witten, Germany.
⁸ State of North Rhine-Westphalia / Regional Government, Duesseldorf, Germany.
⁹ Department of Medical Intensive Care, University Hospital of Basel, Basel, Switzerland.

Abstract

Background: Medical 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.

Methods: Physicians 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 registration: DRKS, DRKS00024781. Registered 16 March 2021-Retrospectively registered, http://www.drks.de/DRKS00024781 .

Results: Eighty 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).

Conclusions: In 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.

Keywords: CPR; Cognitive aid; Medical education; Patient care; Patient safety; Simulation.

Publication types

Randomized Controlled Trial

MeSH terms

Anesthesiology* / education
Cognition
Emergencies*
Humans
Prospective Studies
Single-Blind Method