Does an electronic cognitive aid have an effect on the management of severe gynaecological TURP syndrome? A prospective, randomised simulation study

Abstract

BackgroundLack of familiarity with the content of current guidelines is a major factor associated with non-compliance by clinicians. It is conceivable that cognitive aids with regularly updated medical content can guide clinicians’ task performance by evidence-based practices, even if they are unfamiliar with the actual guideline. Acute hyponatraemia as a consequence of TURP syndrome is a rare intraoperative event, and current practice guidelines have changed from slow correction to rapid correction of serum sodium levels. The primary objective of this study was to compare the management of a simulated severe gynaecological transurethral resection of the prostate (TURP) syndrome under spinal anaesthesia with either: an electronic cognitive aid, or with management from memory alone. The secondary objective was to assess the clinical relevance and participant perception of the usefulness of the cognitive aid.MethodsAnaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. We identified eight evidence-based management tasks for severe TURP syndrome from current guidelines and subdivided them into acute heart failure (AHF)/pulmonary oedema tasks (5) and acute hyponatraemia tasks (3). Implementation of the treatment steps was measured by scoring task items in a binary fashion (yes/no). To assess whether or not the cognitive aid had prompted a treatment step, participants from the cognitive aid group were questioned during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey.ResultsTeams in the cognitive aid group considered evidence-based treatment steps significantly more often than teams of the control group (96% vs. 50% for ‘AHF/pulmonary oedema’ p < 0.001; 79% vs. 12% for ‘acute hyponatraemia’ p < 0.001). Without the cognitive aid, performance would have been comparable across both groups. Nurses, trainees, and consultants derived equal benefit from the cognitive aid.ConclusionsThe cognitive aid improved the implementation of evidence-based practices in a simulated intraoperative scenario. Cognitive aids with current medical content could help to close the translational gap between guideline publication and implementation in acute patient care. It is important that the cognitive aid should be familiar, in a format that has been used in practice and training.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-017-0365-8) contains supplementary material, which is available to authorized users.

Cognitive aids in the management of clinical emergencies: a systematic review

“…In all, 13 randomised controlled trials were included and their findings were reported in 16 publications [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. Details of the screening process are illustrated in Fig.…”

“…2 . Two of the trials were assessed to be at overall low risk of bias [ 27 , 33 , 34 ], nine to have some concerns [ 22 , 23 , 24 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 35 ] and two were at high risk of bias [ 20 , 21 ]. In the 13 instances where clarification of trial methodology or missing data was needed, seven authors responded with the required information [ 22 , 25 , 27 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

“…The development process of the cognitive aid differed between trials and included: consideration of the design and format in two trials [ 20 , 27 ]; literature review, publication guidelines and/or international recommendations in 10 trials [ 20 , 21 , 22 , 23 , 24 , 26 , 27 , 31 , 32 , 33 , 34 , 35 ]; iterative revision until consensus was reached in five trials [ 20 , 23 , 24 , 27 , 31 , 32 ]; and testing in four trials [ 27 , 31 , 32 , 33 , 34 ]. The included cognitive aids consisted of three algorithms [ 20 , 21 , 27 ], seven checklists [ 22 , 23 , 24 , 25 , 31 , 32 , 33 , 34 , 35 ], one hybrid checklist and guideline [ 29 , 30 ] and two in which the type was not specified [ 26 , 28 ]. Seven cognitive aids were presented on paper [ 21 , 22 , 23 , 24 , 25 , 27 , 33 , 34 , 35 ], five electronically [ 20 , 28 …”

The effects of a forced-air warming system plus electric blanket for elderly patients undergoing transurethral resection of the prostate

“…However, this technique is also associated with technical difficulties, takes longer to reach adequate levels of analgesia, can lead to blockade failure; patients can also experience post-dural puncture lumbago and back pain. [ 19 – 21 ] The existing literature predominantly suggests that sensory level should not be greater than T9 in order to observe patient symptoms for potential early TURP syndrome such as versical perforation. [ 22 , 23 ] However, some of the previous reports show that spinal anesthesia can significantly impair thermoregulation by altering afferent thermal inputs, inhibiting vasomotor and shivering responses, redistributing body heat, and predisposing patients to perioperative hypothermia.…”

Data Model Requirements for a Digital Cognitive Aid for Anesthesia to Support Intraoperative Crisis Management

“…To date, the evidence supporting the use of digital CAs instead of paper-based CAs is still inconclusive. In some simulation studies, digital CAs significantly improved decision-making and treatment, 9,10 whereas other studies did not observe any advantage when using a screenbased CA. 11 However, it appears that familiarization and training with the CA is of greater importance for successful implementation than the format (e.g., paper or electronic) itself.…”