A Cognitive Template for Management of Perioperative Adverse Events

Perioperative crisis management commonly involves both rapid generic responses and slower abstract reasoning for the successful management of adverse events. A metacognitive approach to this process offers the potential for minimizing errors and thereby improving outcomes. One such metacognitive technique uses templates that guide dynamic decisionmaking. Because stressful circumstances impair memory and cognitive function, templates may be particularly useful during crises both to improve functional recall and to provide mental constructs that compel anesthesia providers to organize their thoughts and direct approaches to problem-solving that rely on critical thinking rather than solely on heuristics. A six-step cognitive template is proposed for formulating a working diagnosis and deciding appropriate therapy during a perioperative adverse event. The template utilizes overlapping differential diagnoses organized using principles of anatomy and/or physiology. It has been effective in nurse anesthesia training to promote a metacognitive approach to decisionmaking during such events, and the template can be widely utilized in nonacademic settings for similar purposes.