Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

Koers, Lena; Haperen, Maartje van; Meijer, Clemens G. F.; Wandelen, Suzanne B. E. van; Waller, Elbert; Dongelmans, Dave A.; Boermeester, Marja A.; Hermanides, Jeroen; Preckel, Benedikt

doi:10.1001/jamasurg.2019.4704

Cited by 19 publications

(38 citation statements)

References 46 publications

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“…The use of cognitive aids can also help the team in the critical management of the deteriorating patient, with one study in a simulation environment reporting a decreasing in the percentage of omitted critical management steps of 70% [48]. Besides cognitive aids, the use of checklists structuring responses to clinical deterioration has potential to improve patient care and outcomes, since the first responders on the efferent limb are frequently an assembly of available providers of care with limited experience in managing emergency situations [28].…”

Section: Resultsmentioning

confidence: 99%

“…Cognitive aids aim to improve communication, teamwork and leadership and the surgical safety culture and accelerate escalation of care and optimize resuscitation by lowering omitted management steps, and therefore have potential to reduce FTR [48]. Despite the potential benefit in implementing this strategy to reduce FTR, there is still not a widespread use in clinical practice [48]. in the management of common emergencies while escalation to rapid response teams occur [14].…”

Section: Efferent Limbmentioning

confidence: 99%

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Failure To Rescue, What Can Be Done To Prevent It?

Pedro

Maria

Humberto

2021

EJBMR

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Introduction: Failure to Rescue (FTR) is the failure to prevent a patient’s death after a complication. It measures the ability of a hospital to prevent the death of patients who develop one or more complication that was not present at the time of admission. Therefore, the aim of this study is to review the factors that contribute to FTR, and the measures and strategies that can be applied to prevent the FTR events, in order to discuss the best way to improve patient outcomes in the hospital setting. Methods: A search was conducted on PUBMED retrieving a total of 464 articles. A review of the selected articles’ bibliography was conducted to find other relevant articles. Sixty studies were reviewed in this paper. Results: Patient factors as increasing age, comorbidities and frailty increase the risk of FTR, as well as an increasing number of complications. Several hospital factors, nursing care, and microsystem also influence FTR. Some track and Trigger Systems (TTS) and Early Warning Scores (EWS) have been shown to predict clinical deterioration. On the other hand, machine learning systems have outperformed EWS. Rapid response teams have become the standard approach to delivery and escalation of care, and cognitive aids and crisis checklists also have potential to help reduce FTR. Conclusion: Patient and hospital factors are often non-modifiable; thus, microsystem factors could be a target for improvement. Creating clinical pathways can improve surveillance, and communication tools like SBAR can help relay information. EWS, machine learning models and continuous monitoring are strategies that can help detect clinical deterioration. In the efferent limb rapid response teams have shown to reduce FTR.

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Section: Resultsmentioning

confidence: 99%

Section: Efferent Limbmentioning

confidence: 99%

Failure To Rescue, What Can Be Done To Prevent It?

Pedro

Maria

Humberto

2021

EJBMR

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“…Research involving simulation supports the use of cognitive aids in anaesthesia, as well as in other fields of medicine [39–42]. Despite the increased focus on human factors in anaesthesia, and the known evidence supporting the use of cognitive aids to reduce slips, lapses and mistakes, cognitive aids were not included in four guidelines, and mentioned but not presented in an additional 15, totalling 19 of 26 (73%) [43].…”

Section: Discussionmentioning

confidence: 99%

Prevalence and commonality of non‐technical skills and human factors in airway management guidelines: a narrative review of the last 5 years

et al. 2022

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Summary The primary aim of this review was to identify, analyse and codify the prominence and nature of human factors and ergonomics within difficult airway management algorithms. A directed search across OVID Medline and PubMed databases was performed. All articles were screened for relevance to the research aims and according to predetermined exclusion criteria. We identified 26 published airway management algorithms. A coding framework was iteratively developed identifying human factors and ergonomic specific words and phrases based on the Systems Engineering Initiative for Patient Safety model. This framework was applied to the papers to delineate qualitative and quantitative results. Our results show that human factors are well represented within recent airway management guidelines. Human factors associated with work systems and processes featured more prominently than user and patient outcome measurement and adaption. Human factors are an evolving area in airway management and our results highlight that further considerations are necessary in further guideline development.

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“… 4 Albeit small, pre-intervention and post-intervention studies have reported mixed outcomes when escalating therapy in response to early warning signs. 9 , 16 Simulation studies have shown that the use of cognitive aids (similar to the ASOS-2 bedside guide) can decrease the omission of critical management steps, 17 with fewer critical errors. 18 Feedback on patient outcomes can reduce major adverse events following surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, approximately 30% of all deaths within 30 days of surgery occur after hospital discharge globally, 7 and we expect a higher proportion of patients to die following discharge in resource-limited environments. 4,25 The key learning points from this study are that future attempts to provide pragmatic interventions for surgical patients with physiological deterioration in a resource-limited environment will need to be codesigned by all local role players to ensure appropriate buy-in with the risk stratification strategy, teamwork necessary to implement the intervention, application of cognitive aids, 17 communication of risk within the team, 9 and feedback on outcomes and performance. 19 Implementation strategies for resource-limited environments must include the use of educational meetings, tailoring and practising inter ventions, leverage of local leaders, and provision of feedback to change health-care provider behaviour.…”

Section: Discussionmentioning

confidence: 99%

Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial

Biccard¹,

Toit²,

Lesosky³

et al. 2021

The Lancet Global Health

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Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federati...

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Effect of Cognitive Aids on Adherence to Best Practice in the Treatment of Deteriorating Surgical Patients

Cited by 19 publications

References 46 publications

Failure To Rescue, What Can Be Done To Prevent It?

Failure To Rescue, What Can Be Done To Prevent It?

Prevalence and commonality of non‐technical skills and human factors in airway management guidelines: a narrative review of the last 5 years

Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial

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