Novel cricothyrotomy assessment tool for attending physicians: A multicenter study of an error avoidance checklist

Abstract

Background This study used existing literature and expert feedback to develop and pilot a novel error‐avoidance checklist tool for cricothyrotomy in attending physicians. Prior literature has not focused on expert cricothyrotomy performance. While published checklists teach a specific procedural method, ideal for novice learners, this may hinder expert learners. Objectives We endeavored to create a succinct error‐avoidance checklist for cricothyrotomy. We hypothesized that such a checklist would prove feasible and acceptable to attending physicians. Methods This is a multicenter prospective checklist creation, evaluation, and feasibility study. Multiple experts pursued an iterative process to reach consensus on a 7‐item error‐avoidance checklist. The checklist was trialed for feasibility in pilot sessions at two sites by 45 attending emergency physicians who used the checklist for peer performance assessment and provided feedback. Results During the pilot implementation, 94% of respondents completed the procedure within the allotted 120 s. Greater than 85% of respondents agreed that four of the five procedural errors on the checklist were very or somewhat critical to avoid, including cutting >2 cm from midline, creating a false passage, failing to continuously maintain an object in the trachea, and injuring oneself during the procedure. Only 66% of participants felt severing the cricoid cartilage was critical. Successful breath administration and time under 120 s were critical for 100% and 95% of participants, respectively. The checklist was rated “easy” or “very easy” to use by 93% of participants, and 95% found this checklist reasonable for evaluating attending physicians. Conclusions We present the multicenter development and implementation of a novel error‐avoidance checklist tool for use in expert cricothyrotomy performance. Attending emergency medicine (EM) physicians rated our tool easy to use and agreed that most of the proposed errors were critical. Participants overwhelmingly agreed this tool would be reasonable for evaluation of cricothyrotomy performance among attending EM physicians.

An investigation into emergency medicine resident cricothyrotomy competency: Is three the magic number?

“…Similarly, variability in clinical status means that no single time is applicable to all real‐life patients. Nevertheless, with a mean time of approximately 41 sec at attempt number six, completion times in our study were similar to that of multiple other studies 14,15,21 and below the maximum procedure times recommended by other authors 19,24 …”

“…We chose time to procedure completion as our primary outcome because it is easy to measure with a high degree of accuracy and it has been used as an outcome of interest in multiple previous cricothyrotomy studies 14,15,18–23 . Several authors have noted this as an important outcome for this procedure given the clinical importance of time in the emergent situation in which the procedure is invariably performed 15,19,22,24 . Unlike some studies, we did not set a threshold time for successful performance because variability in model, technique, equipment used, and definition of time preclude direct comparisons from study to study.…”

“…Nevertheless, with a mean time of approximately 41 sec at attempt number six, completion times in our study were similar to that of multiple other studies 14,15,21 and below the maximum procedure times recommended by other authors. 19,24 Unlike Wong and Shetty, our study measured retention 1 year after initial training. Some studies have shown a significant deterioration in resuscitative skills with time.…”

“… 14 , 15 , 18 , 19 , 20 , 21 , 22 , 23 Several authors have noted this as an important outcome for this procedure given the clinical importance of time in the emergent situation in which the procedure is invariably performed. 15 , 19 , 22 , 24 Unlike some studies, we did not set a threshold time for successful performance because variability in model, technique, equipment used, and definition of time preclude direct comparisons from study to study. Similarly, variability in clinical status means that no single time is applicable to all real‐life patients.…”

A WeChat-based competency and performance checklist in basic surgical skills course for military medical academy undergraduates

“…Checklists have shown potential value and benefit for human intensive and multi-step procedures with high complexity, so as to promote consistency and completeness to carry out specific tasks. Apart from surgical procedures, it has also been adopted in nursing skills training [ 8 , 9 ], emergency life support training [ 10 , 11 ], and in other forms of medical teaching activities [ 12 ]. These studies share one concept in common, that is, although the content of the checklist is designed by investigators or instructors, the checklist yield benefit and values for users themselves by means of self-evaluation and self-reflection, which is in accordance with the intention of our study.…”