Cognitive Aids for Role Definition (CARD) to improve interprofessional team crisis resource management: An exploratory study

Abstract

This study aimed to assess the perceived value of the Cognitive Aids for Role Definition (CARD) protocol for simulated intraoperative cardiac arrests. Sixteen interprofessional operating room teams completed three consecutive simulated intraoperative cardiac arrest scenarios: current standard, no CARD; CARD, no CARD teaching; and CARD, didactic teaching. Each team participated in a focus group interview immediately following the third scenario; data were transcribed verbatim and qualitatively analysed. After 6 months, participants formed eight new teams randomised to two groups (CARD or no CARD) and completed a retention intraoperative cardiac arrest simulation scenario. All simulation sessions were video recorded and expert raters assessed team performance. Qualitative analysis of the 16 focus group interviews revealed 3 thematic dimensions: role definition in crisis management; logistical issues; and the "real life" applicability of CARD. Members of the interprofessional team perceived CARD very positively. Exploratory quantitative analysis found no significant differences in team performance with or without CARD (p > 0.05). In conclusion, qualitative data suggest that the CARD protocol clarifies roles and team coordination during interprofessional crisis management and has the potential to improve the team performance. The concept of a self-organising team with defined roles is promising for patient safety.

A Fundamental Cognitive Taxonomy for Cognition Aids

“…A surgical checklist, for example, might provide information support via one step where all team members must announce their name and role, but in other steps, it might provide decision support for actions to take in event of heart or lung stoppage (McLaughlin et al, 2016). Another type of aid, role cards attached to surgical team members, would provide the same information support as the aforementioned checklist could, but is not a checklist (Renna et al, 2016). A different checklist might provide none of those supports (WHO, 2015).…”

Education, Implementation, and Teams

“…4. For the important outcome of time to starting CPR in simulated resuscitations, between course conclusion and 1 year we identified very low-certainty evidence in 1 randomized trial, 204 downgraded for indirectness and imprecision. This outcome was evaluated in only 4 resuscitation teams, and there was no difference (15 seconds without versus 14 seconds with cognitive aid).…”

“…7. For the important outcome of CCF/hands-off time (HOT) in simulated resuscitations, between course conclusion and 1 year in simulated resuscitations, we identified very low-certainty evidence in 1 randomized trial, 204 downgraded for risk of bias, indirectness, and imprecision. No significant differences in percentage HOT were found when resuscitation teams used a cognitive aid (18.9% when 4 teams did not versus 15.8% when 4 teams did use a cognitive aid, NS).…”

“…9. For the important outcome of time to start CPR in simulated resuscitations at course conclusion, we identified low-certainty evidence in 4 randomized trials 207À210 (downgraded for risk of bias, indirectness, and imprecision) and 1 observational study 204 (downgraded for risk of bias, indirectness, and imprecision). All studies demonstrated statistically significant and likely clinically significant delays in starting CPR for lay provider participants who used a cognitive aid compared with those who did not 10.…”

“…Actual cardiac arrest studies: Given that resuscitation councils are de facto endorsing the use of cognitive aids by providing pocket cards and algorithm posters, there is an urgent need to adequately study the impact of cognitive aids in the real-world cardiac arrest environment. Simulated cardiac arrest studies with healthcare providers using cognitive aids: The 1 study that examines healthcare provider performance 204 is a very small proof-of-concept pilot study and was not sufficiently powered to be able to demonstrate any effects of cognitive aids on performance in this population. Future, larger studies in this area will allow us to strengthen our recommendation for this provider group.…”