Does every code need a "reader?" improvement of rare event management with a cognitive aid "reader" during a...

Area of Science:

• Medical Education
• Emergency Medicine
• Patient Safety

Background:

• Prompt treatment is crucial for patient survival during medical crises.
• Obstetric cardiac arrest (OCA) and malignant hyperthermia (MH) are rare but critical emergencies.
• Cognitive aids (CAs) can standardize management and decision-making during crises.

Purpose of the Study:

• To investigate a novel method for enhancing resident physician utilization of cognitive aids during simulated OCA and MH crises.
• To assess the impact of a structured intervention on adherence to critical treatment steps.

Main Methods:

• Resident physicians participated in 31 simulated OCA and MH crises.
• A confederate "Reader" prompted or read cognitive aids aloud if residents failed to manage the crisis.
• Resident performance was evaluated before and after the Reader's introduction, scoring critical actions and recording physiological variables.

Main Results:

• Before Reader introduction, no residents completed all critical steps for OCA; CA use was low (22-31%).
• For MH, residents diagnosed and initiated treatment but skipped critical steps, with only 33% using CAs.
• Following Reader introduction, all critical actions for both OCA and MH were successfully completed.

Conclusions:

• The introduction of a Reader significantly improved the execution of all critical actions during simulated obstetric cardiac arrest and malignant hyperthermia crises.
• Residents recognized the value of the Reader in facilitating correct management during debriefing.
• This intervention demonstrates a promising strategy to enhance the effective use of cognitive aids in high-stakes medical scenarios.