Does utilization of an intubation safety checklist reduce omissions during simulated resuscitation scenarios: a multi-center randomized controlled trial

Abstract

Objectives Checklists have been used to decrease adverse events associated with medical procedures. Simulation provides a safe setting in which to evaluate a new checklist. The objective of this study was to determine if the use of a novel peri-intubation checklist would decrease practitioners’ rates of omission of tasks during simulated airway management scenarios. Methods Fifty-four emergency medicine (EM) practitioners from two academic centers were randomized to either their usual approach or use of our checklist, then completed three simulated airway management scenarios. A minimum of two assessors documented the number of tasks omitted and the time until definitive airway management. Discrepancies between assessors were resolved by single assessor video review. Participants also completed a post-simulation survey. Results The average percentage of omitted tasks over three scenarios was 45.7% in the control group ( n = 25) and 13.5% in the checklist group ( n = 29)—an absolute difference of 32.2% (95% CI 27.8, 36.6%). Time to definitive airway management was longer in the checklist group in the first two of three scenarios (difference of 110.0 s, 95% CI 55.0 to 167.0; 83.0 s, 95% CI 35.0 to 128.0; and 36.0 s, 95% CI −18.0 to 98.0 respectively). Conclusions In this dual-center, randomized controlled trial, use of an airway checklist in a simulated setting significantly decreased the number of important airway tasks omitted by EM practitioners, but increased time to definitive airway management. Electronic supplementary material The online version of this article (10.1007/s43678-020-00010-w) 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 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 , 29 , 30 , 31 , 32 ] and one electronically and on paper [ 26 ]. In seven trials, the participating clinicians had the opportunity to familiarise themselves with the cognitive aid before use [ 21 , 22 , 23 , 24 , 27 , 29 , 30 , 31 , 32 ] and in three trials, the process of familiarisation was not specified [ 20 , 26 , 33 , 34 ].…”

Airway management in hospital. Methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” (third edition)

“…Применение чек-листов при подготовке и выполнении интубации показало свою эффективность в отношении снижения частоты осложнений, развития гипоксемии и ошибок у разных категорий пациентов, в ряде случаев их применение незначимо увеличивает время подготовки к интубации [235][236][237][238][239][240]. Разработка чек-листов рекомендована рядом экспертов и профессиональных организаций как средство обеспечения безопасности пациентов во время ИТ [241][242].…”