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Medical crisis checklists in the emergency department : a simulation-based multi-institutional randomised controlled trial

Dryver, Eric LU ; Lundager Forberg, Jakob LU ; Hård Af Segerstad, Caroline ; Dupont, William D. ; Bergenfelz, Anders LU and Ekelund, Ulf LU (2021) In BMJ Quality and Safety
Abstract

Background: Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. Methods: Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs - of which two belong to an academic centre - and managed by resuscitation teams during their clinical shifts. A... (More)

Background: Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. Methods: Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs - of which two belong to an academic centre - and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed. Results: A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10-8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1-6, most participants agreed (gave a score of 5 or 6) with the statement 'I would use the checklist if I got a similar case in reality'. Conclusion: In this multi-institution study, checklists markedly improved local resuscitation teams' management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
checklists, crisis management, simulation, team training
in
BMJ Quality and Safety
publisher
BMJ Publishing Group
external identifiers
  • pmid:33597283
  • scopus:85100910290
ISSN
2044-5415
DOI
10.1136/bmjqs-2020-012740
language
English
LU publication?
yes
id
f44fc2eb-293a-45a6-8aef-aad8c8038207
date added to LUP
2021-03-04 10:29:04
date last changed
2021-06-16 01:41:20
@article{f44fc2eb-293a-45a6-8aef-aad8c8038207,
  abstract     = {<p>Background: Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown. Methods: Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs - of which two belong to an academic centre - and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed. Results: A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10-8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1-6, most participants agreed (gave a score of 5 or 6) with the statement 'I would use the checklist if I got a similar case in reality'. Conclusion: In this multi-institution study, checklists markedly improved local resuscitation teams' management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality. </p>},
  author       = {Dryver, Eric and Lundager Forberg, Jakob and Hård Af Segerstad, Caroline and Dupont, William D. and Bergenfelz, Anders and Ekelund, Ulf},
  issn         = {2044-5415},
  language     = {eng},
  month        = {02},
  publisher    = {BMJ Publishing Group},
  series       = {BMJ Quality and Safety},
  title        = {Medical crisis checklists in the emergency department : a simulation-based multi-institutional randomised controlled trial},
  url          = {http://dx.doi.org/10.1136/bmjqs-2020-012740},
  doi          = {10.1136/bmjqs-2020-012740},
  year         = {2021},
}