A randomised controlled trial of cognitive aids for emergency airway equipment preparation in a Paediatric Emergency Department

Abstract

BackgroundSafety of emergency intubation may be improved by standardising equipment preparation; the efficacy of cognitive aids is unknown.MethodsThis randomised controlled trial compared no cognitive aid (control) with the use of a checklist or picture template for emergency airway equipment preparation in the Emergency Department of The Royal Children’s Hospital, Melbourne.ResultsSixty-three participants were recruited, 21 randomised to each group. Equal numbers of nursing, junior medical, and senior medical staff were included in each group. Compared to controls, the checklist or template group had significantly lower equipment omission rates (median 30 % IQR 20–40 % control, median 10 % IQR 5–10 % checklist, median 10 % IQR 5–20 % template; p < 0.05). The combined omission rate and sizing error rate was lower using a checklist or template (median 35 % IQR 30–45 % control, median 15 % IQR 10–20 % checklist, median 15 % IQR 10–30 % template; p < 0.05). The template group had less variation in equipment location compared to checklist or controls. There was no significant difference in preparation time in controls (mean 3 min 14 s sd 56 s) compared to checklist (mean 3 min 46 s sd 1 min 15 s) or template (mean 3 min 6 s sd 49 s; p = 0.06).DiscussionTemplate use reduces variation in airway equipment location during preparation foremergency intubation, with an equivalent reduction in equipment omission rate to the use of a checklist. The use of a template for equipment preparation and a checklist for team, patient, and monitoring preparation may provide the best combination of both cognitive aids.ConclusionsThe use of a cognitive aid for emergency airway equipment preparation reduces errors of omission. Template utilisation reduces variation in equipment location.Trial registrationAustralian and New Zealand Trials Registry (ACTRN12615000541505).Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0201-z) contains supplementary material, which is available to authorized users.

Optimising remote site airway management kit dump using the SCRAM bag—a randomised controlled trial

“…Standardising the kit dump process and the use of cognitive aids reduces the number of decisions an operator must make, ensures equipment availability and has been recommended as a strategy for reducing error (Schnittker et al, 2018;Benger & Hopkinson, 2011;Marshall, 2013;Lockey et al, 2014;Long et al, 2016;Chrimes, 2016). We observed that those using the SCRAM bag performed a kit dump significantly quicker.…”

Emergency intubation of children outside of the operating room

“…This is especially relevant for intubations performed in the prehospital setting or during retrievals. Lack of familiarity with available equipment or its location may increase operator cognitive load, may delay planning for initial and subsequent intubation attempts, and may contribute to errors of omission or commission during emergency airway management . Team and equipment ergonomics may contribute to situational difficulties, as may behavioral factors in young or agitated children.…”

“…Strategies to address this issue include standardization and simplification of airway equipment, and locating airway equipment in identical trolleys in all critical care areas . In addition, the use of cognitive aids in the forms of templates or checklists may help standardize specific equipment and its layout . Team and equipment ergonomics may contribute to situationally difficult airways, particularly in young children and infants, whose small size relative to that of the treating team significantly limits patient access.…”

Helping experts and expert teams perform under duress: an agenda for cognitive aid research

“…In recent years, there has been a keen interest in how checklists and other cognitive aids can help clinicians during clinical crises. Studies from anaesthesia , and emergency medicine have shown that displaying cognitive aids during emergencies reduces omissions, time to perform tasks and improves team skills, communication and performance in most instances . In research where no difference was found, the cognitive aids are almost always found to have been introduced without education or have flaws in their physical design .…”