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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.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|May 17, 2020
PubMed

Insights

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.
Abstract

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