Effect of a Cognitive Aid on Adherence to Perioperative Assessment and Management Guidelines for the Cardiac Evaluation of Noncardiac Surgical Patients

Abstract

BACKGROUND-The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline.

Initial Experience of the American Society of Regional Anesthesia and Pain Medicine Coags Regional Smartphone Application

“…6,7 The use of DSTs has been shown to enhance compliance with guidelines, protocols, and best practices as well as improve outcomes in both simulation and direct patient care. [8][9][10][11][12][13][14][15] Electronic DSTs (eDSTs) in particular, due to their flexibility and integration into clinician workflow, have shown success in improving care by increasing adherence to published guidelines and protocols. [10][11][12][13][14][15][16] Because smartphones are rapidly becoming integral to physicians, and smartphone applications (apps) are becoming more commonplace, the app platform becomes a logical modality for an eDST to be used as a supplement to printed guidelines.…”

“…19 The document is 31 pages long, and as with other guidelines, correctly applying these recommendations to clinical situations can often be a challenge. 8,20 However, our group has shown that these guidelines and others can be presented in smartphone app form and that use of such apps improves the adherence to guidelines in simulated clinical encounters. 8,20,21 As such, understanding the actual real-world use of guideline apps is needed to guide medical specialties and component societies in the ongoing development and distribution of clinical practice guidelines.…”

“…8,20 However, our group has shown that these guidelines and others can be presented in smartphone app form and that use of such apps improves the adherence to guidelines in simulated clinical encounters. 8,20,21 As such, understanding the actual real-world use of guideline apps is needed to guide medical specialties and component societies in the ongoing development and distribution of clinical practice guidelines. Accordingly, we report the consumption and use of the ASRA Coags Regional iOS (Apple, Inc, Cupertino, California) and Android (Google, Mountain View, California) apps in the first year after release, which were developed as an eDST based on the 2010 Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy (Third Edition) guidelines.…”