Abstract
BackgroundLack of familiarity with the content of current guidelines is a major factor associated with non-compliance by clinicians. It is conceivable that cognitive aids with regularly updated medical content can guide clinicians’ task performance by evidence-based practices, even if they are unfamiliar with the actual guideline. Acute hyponatraemia as a consequence of TURP syndrome is a rare intraoperative event, and current practice guidelines have changed from slow correction to rapid correction of serum sodium levels. The primary objective of this study was to compare the management of a simulated severe gynaecological transurethral resection of the prostate (TURP) syndrome under spinal anaesthesia with either: an electronic cognitive aid, or with management from memory alone. The secondary objective was to assess the clinical relevance and participant perception of the usefulness of the cognitive aid.MethodsAnaesthetic teams were allocated to control (no cognitive aid; n = 10) or intervention (cognitive aid provided; n = 10) groups. We identified eight evidence-based management tasks for severe TURP syndrome from current guidelines and subdivided them into acute heart failure (AHF)/pulmonary oedema tasks (5) and acute hyponatraemia tasks (3). Implementation of the treatment steps was measured by scoring task items in a binary fashion (yes/no). To assess whether or not the cognitive aid had prompted a treatment step, participants from the cognitive aid group were questioned during debriefing on every single treatment step. At the end of the simulation, session participants were asked to complete a survey.ResultsTeams in the cognitive aid group considered evidence-based treatment steps significantly more often than teams of the control group (96% vs. 50% for ‘AHF/pulmonary oedema’ p < 0.001; 79% vs. 12% for ‘acute hyponatraemia’ p < 0.001). Without the cognitive aid, performance would have been comparable across both groups. Nurses, trainees, and consultants derived equal benefit from the cognitive aid.ConclusionsThe cognitive aid improved the implementation of evidence-based practices in a simulated intraoperative scenario. Cognitive aids with current medical content could help to close the translational gap between guideline publication and implementation in acute patient care. It is important that the cognitive aid should be familiar, in a format that has been used in practice and training.
Highlights
Lack of familiarity with the content of current guidelines is a major factor associated with noncompliance by clinicians
One team from the Cognitive aid (CA) group and one team from the control group attributed seizures to “Local Anaesthetic Systemic Toxicity” (LAST) and started lipid resuscitation. In both of these teams, no critical steps for severe acute hyponatraemia were performed so that the two scenarios were excluded from further analysis
Our primary finding suggests that an electronic CA can improve implementation of recommended tasks for acute heart failure (AHF)/pulmonary oedema, and can prompt clinicians to a rapid correction of acute hyponatraemia in a simulated case of severe gynaecological Transurethral resection of the prostate (TURP) syndrome
Summary
Lack of familiarity with the content of current guidelines is a major factor associated with noncompliance by clinicians. Crisis-related cognitive aids (CAs) such as ‘emergency manuals’ [6], ‘emergency quick reference guides’ [7, 8], and ‘crisis checklists’ [9], have been developed for a variety of intraoperative emergencies, to assist clinicians in executing the complex decision making involved in diagnosis and therapy. They contain current medical content and provide localised information (e.g., important phone numbers, storage for rarely used drugs) that may help increase the speed and fluidity of performance [10,11,12]
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