R Lelaidier1,2, B Balança1,3,4, S Boet5,6, A Faure1,2, M Lilot1,7,8, F Lecomte8, J-J Lehot1,4,8, T Rimmelé1,2,9,10, J-C Cejka1,2. 1. Centre Lyonnais d'Enseignement par la Simulation en Santé, SAMSEI, Université Claude Bernard Lyon 1, Lyon, France. 2. Département d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 place d'Arsonval, 69003 Lyon, France. 3. Inserm U1028, CNRS UMR 5292, Centre de Recherche en Neurosciences, Team TIGER, Lyon, France. 4. Département d'Anesthésie-Réanimation, Hôpital Pierre Wertheimer, Bron, France. 5. Department of Anaesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada. 6. Department of Innovation in Medical Education, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. 7. Département d'Anesthésie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France. 8. Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France. 9. Département des Urgences, Hôpital Cochin, Paris, France. 10. EA 7426 Hospices Civils de Lyon-bioMérieux-Université Claude Bernard Lyon 1 'Pathophysiology of Injury Induced Immunosuppression', France.
Abstract
BACKGROUND: Cognitive aids improve the technical performance of individuals and teams dealing with high-stakes crises. Hand-held electronic cognitive aids have rarely been investigated. A randomized controlled trial was conducted to investigate the effects of a smartphone application, named MAX (for Medical Assistance eXpert), on the technical and non-technical performance of anaesthesia residents dealing with simulated crises. METHODS: This single-centre randomized, controlled, unblinded trial was conducted in the simulation centre at Lyon, France. Participants were anaesthesia residents with >1 yr of clinical experience. Each participant had to deal with two different simulated crises with and without the help of a digital cognitive aid. The primary outcome was technical performance, evaluated as adherence to guidelines. Two independent observers remotely assessed performance on video recordings. RESULTS: Fifty-two residents were included between July 2015 and February 2016. Six participants were excluded for technical issues; 46 participants were confronted with a total of 92 high-fidelity simulation scenarios (46 with MAX and 46 without). Mean (sd) age was 27 (1.8) yr and clinical experience 3.2 (1.0) yr. Inter-rater agreement was 0.89 (95% confidence interval 0.85-0.92). Mean technical scores were higher when residents used MAX [82 (11.9) vs 59 (10.8)%; P<0.001]. CONCLUSION: The use of a hand-held cognitive aid was associated with better technical performance of residents dealing with simulated crises. These findings could help digital cognitive aids to find their way into daily medical practice and improve the quality of health care when dealing with high-stakes crises. CLINICAL TRIAL REGISTRATION: NCT02678819.
BACKGROUND: Cognitive aids improve the technical performance of individuals and teams dealing with high-stakes crises. Hand-held electronic cognitive aids have rarely been investigated. A randomized controlled trial was conducted to investigate the effects of a smartphone application, named MAX (for Medical Assistance eXpert), on the technical and non-technical performance of anaesthesia residents dealing with simulated crises. METHODS: This single-centre randomized, controlled, unblinded trial was conducted in the simulation centre at Lyon, France. Participants were anaesthesia residents with >1 yr of clinical experience. Each participant had to deal with two different simulated crises with and without the help of a digital cognitive aid. The primary outcome was technical performance, evaluated as adherence to guidelines. Two independent observers remotely assessed performance on video recordings. RESULTS: Fifty-two residents were included between July 2015 and February 2016. Six participants were excluded for technical issues; 46 participants were confronted with a total of 92 high-fidelity simulation scenarios (46 with MAX and 46 without). Mean (sd) age was 27 (1.8) yr and clinical experience 3.2 (1.0) yr. Inter-rater agreement was 0.89 (95% confidence interval 0.85-0.92). Mean technical scores were higher when residents used MAX [82 (11.9) vs 59 (10.8)%; P<0.001]. CONCLUSION: The use of a hand-held cognitive aid was associated with better technical performance of residents dealing with simulated crises. These findings could help digital cognitive aids to find their way into daily medical practice and improve the quality of health care when dealing with high-stakes crises. CLINICAL TRIAL REGISTRATION: NCT02678819.
Keywords:
Clinical Decision Support Systems; Decision Support Techniques; Group Processes; Manikins; Patient Care Team/organization & administration; Simulation Training; User-Computer Interface; audiovisual aids
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