Larry C Field1, Matthew D McEvoy2, Jeremy C Smalley3, Carlee A Clark4, Michael B McEvoy5, Horst Rieke6, Paul J Nietert7, Cory M Furse8. 1. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: field@musc.edu. 2. Department of Anesthesiology, Vanderbilt University, 2301 Vanderbilt University Hospital, Nashville, TN 37232-7237, United States. Electronic address: matthew.d.mcevoy@vanderbilt.edu. 3. Department of Orthopedics, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: smalley@musc.edu. 4. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: clarca@musc.edu. 5. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: mcevoym@musc.edu. 6. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: riekeh@musc.edu. 7. Department of Medicine, Division of Biostatistics and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Room 303J, Charleston, SC 29425, United States. Electronic address: nieterpj@musc.edu. 8. Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: furse@musc.edu.
Abstract
INTRODUCTION: Adherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA. METHODS: After IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists. RESULTS: Performance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p<0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors vs. 3.8 errors, p<0.012). CONCLUSION: Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.
INTRODUCTION: Adherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA. METHODS: After IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists. RESULTS: Performance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p<0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors vs. 3.8 errors, p<0.012). CONCLUSION: Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.
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