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Cognitive aids with roles defined (CARD) for obstetrical crises: a multisite before-and-after cohort study
Sylvain Boet1,2,3, Glenn Posner4,5,6, Erika Bariciak7
1Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada. sboet@toh.on.ca.
Summary
The cognitive aids with roles defined (CARD) did not improve outcomes for emergency Cesarean deliveries. This study found no significant changes in delivery time or maternal/neonatal clinical results after implementing CARD.
Area of Science:
- Obstetrics and Gynecology
- Healthcare Management
- Patient Safety
Background:
- Effective teamwork is crucial for managing obstetrical emergencies.
- Cognitive aids can support interprofessional team coordination during crises.
- The Cognitive Aids with Roles Defined (CARD) tool aims to improve crisis management in healthcare.
Purpose of the Study:
- To evaluate the clinical impact of implementing the CARD cognitive aid during emergency Cesarean deliveries.
- To assess if CARD improves time-based and clinical outcomes in high-risk obstetrical situations.
Main Methods:
- A prospective before-and-after cohort trial was conducted across two Canadian academic hospital maternity units.
- One campus received training on CARD (intervention), while the other did not (control).
- Data from 267 emergency Cesarean deliveries were analyzed, focusing on time to delivery and maternal/neonatal clinical outcomes.
Main Results:
- Implementation of CARD did not significantly alter the median time to delivery for emergency Cesarean sections (17 vs. 15 minutes).
- No significant improvements were observed in secondary outcomes, including specific time intervals or clinical results for mothers and newborns.
- Statistical analysis showed no significant difference between the pre-intervention and post-intervention periods (P = 0.36).
Conclusions:
- The CARD cognitive aid did not demonstrate a significant benefit in improving time-based or clinical outcomes for emergency Cesarean deliveries.
- Further research may be needed to explore alternative or modified cognitive aids for obstetrical crisis management.
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