Use of an Electronic Decision Support Tool Improves Management of Simulated In-hospital Cardiac Arrest

Overview

Journal Resuscitation

Specialty Emergency Medicine

Date 2013 Sep 24

PMID 24056391

Citations 19

Authors

Larry C Field

Matthew D McEvoy

Jeremy C Smalley

Carlee A Clark

Michael B McEvoy

Horst Rieke

Paul J Nietert

Cory M Furse

Affiliations

Soon will be listed here.

Abstract

Introduction: Adherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA.

Methods: After IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists.

Results: Performance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p<0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors vs. 3.8 errors, p<0.012).

Conclusion: Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.

Citing Articles

[Treatment quality with and without an electronic cognitive aid for emergencies in anaesthesia (eGENA) : The DANGER pilot study part 2 in randomized controlled in-situ emergency simulations].

Ruckert F, Truxa V, Dussmann P, Schmidt T, Seyfried T Anaesthesiologie. 2025; 74(1):15-23.

PMID: 39794633 DOI: 10.1007/s00101-024-01493-3.

An Advanced Cardiac Life Support Application Improves Performance during Simulated Cardiac Arrest.

Senter-Zapata M, Neel D, Colocci I, Alblooshi A, AlRadini F, Quach B Appl Clin Inform. 2024; 15(4):798-807.

PMID: 39357878 PMC: 11446628. DOI: 10.1055/s-0044-1788979.

Cognitive aids used in simulated resuscitation: A systematic review.

Nabecker S, Nation K, Gilfoyle E, Abelairas-Gomez C, Koota E, Lin Y Resusc Plus. 2024; 19:100675.

PMID: 38873274 PMC: 11170275. DOI: 10.1016/j.resplu.2024.100675.

Effectiveness of a Novel Tablet Application in Reducing Guideline Deviations During Pediatric Cardiac Arrest: A Randomized Clinical Trial.

Corazza F, Arpone M, Tardini G, Stritoni V, Mormando G, Graziano A JAMA Netw Open. 2023; 6(8):e2327272.

PMID: 37535352 PMC: 10401301. DOI: 10.1001/jamanetworkopen.2023.27272.

The impact of cognitive aids on resuscitation performance in in-hospital cardiac arrest scenarios: a systematic review and meta-analysis.

Corazza F, Fiorese E, Arpone M, Tardini G, Frigo A, Cheng A Intern Emerg Med. 2022; 17(7):2143-2158.

PMID: 36031672 PMC: 9420676. DOI: 10.1007/s11739-022-03041-6.

References

Gass D, Curry L . Physicians' and nurses' retention of knowledge and skill after training in cardiopulmonary resuscitation. Can Med Assoc J. 1983; 128(5):550-1. PMC: 1874955. View

Devries K, Kenward M, Free C . Preventing smoking relapse using text messages: analysis of data from the txt2stop trial. Nicotine Tob Res. 2012; 15(1):77-82. DOI: 10.1093/ntr/nts086. View

Merchant R, Abella B, Abotsi E, Smith T, Long J, Trudeau M . Cell phone cardiopulmonary resuscitation: audio instructions when needed by lay rescuers: a randomized, controlled trial. Ann Emerg Med. 2010; 55(6):538-543.e1. DOI: 10.1016/j.annemergmed.2010.01.020. View

Haut E, Lau B, Kraenzlin F, Hobson D, Kraus P, Carolan H . Improved prophylaxis and decreased rates of preventable harm with the use of a mandatory computerized clinical decision support tool for prophylaxis for venous thromboembolism in trauma. Arch Surg. 2012; 147(10):901-7. DOI: 10.1001/archsurg.2012.2024. View

Semeraro F, Marchetti L, Frisoli A, Cerchiari E, Perkins G . Motion detection technology as a tool for cardiopulmonary resuscitation (CPR) quality improvement. Resuscitation. 2011; 83(1):e11-2. DOI: 10.1016/j.resuscitation.2011.07.043. View

Abella B, Sandbo N, Vassilatos P, Alvarado J, OHearn N, Wigder H . Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest. Circulation. 2005; 111(4):428-34. DOI: 10.1161/01.CIR.0000153811.84257.59. View

Litvin C, Ornstein S, Wessell A, Nemeth L, Nietert P . Use of an electronic health record clinical decision support tool to improve antibiotic prescribing for acute respiratory infections: the ABX-TRIP study. J Gen Intern Med. 2012; 28(6):810-6. PMC: 3663943. DOI: 10.1007/s11606-012-2267-2. View

Free C, Phillips G, Galli L, Watson L, Felix L, Edwards P . The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: a systematic review. PLoS Med. 2013; 10(1):e1001362. PMC: 3548655. DOI: 10.1371/journal.pmed.1001362. View

Arriaga A, Bader A, Wong J, Lipsitz S, Berry W, Ziewacz J . Simulation-based trial of surgical-crisis checklists. N Engl J Med. 2013; 368(3):246-53. DOI: 10.1056/NEJMsa1204720. View

10.

Neal J, Hsiung R, Mulroy M, Halpern B, Dragnich A, Slee A . ASRA checklist improves trainee performance during a simulated episode of local anesthetic systemic toxicity. Reg Anesth Pain Med. 2011; 37(1):8-15. DOI: 10.1097/AAP.0b013e31823d825a. View

11.

McEvoy M, Smalley J, Nietert P, Field L, Furse C, Blenko J . Validation of a detailed scoring checklist for use during advanced cardiac life support certification. Simul Healthc. 2012; 7(4):222-35. PMC: 3467004. DOI: 10.1097/SIH.0b013e3182590b07. View

12.

Litvin C, Ornstein S, Wessell A, Nemeth L, Nietert P . Adoption of a clinical decision support system to promote judicious use of antibiotics for acute respiratory infections in primary care. Int J Med Inform. 2012; 81(8):521-6. DOI: 10.1016/j.ijmedinf.2012.03.002. View

13.

Low D, Clark N, Soar J, Padkin A, Stoneham A, Perkins G . A randomised control trial to determine if use of the iResus© application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency. Anaesthesia. 2011; 66(4):255-62. DOI: 10.1111/j.1365-2044.2011.06649.x. View

14.

Moretti M, Cesar L, Nusbacher A, Kern K, Timerman S, Ramires J . Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. Resuscitation. 2007; 72(3):458-65. DOI: 10.1016/j.resuscitation.2006.06.039. View

15.

Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P . The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med. 2013; 10(1):e1001363. PMC: 3566926. DOI: 10.1371/journal.pmed.1001363. View

16.

Nelson K, Shilkofski N, Haggerty J, Saliski M, Hunt E . The use of cognitive AIDS during simulated pediatric cardiopulmonary arrests. Simul Healthc. 2008; 3(3):138-45. DOI: 10.1097/SIH.0b013e31816b1b60. View

17.

Dane F, Parish D, Durham M, Brown T . In-hospital resuscitation: association between ACLS training and survival to discharge. Resuscitation. 2000; 47(1):83-7. DOI: 10.1016/s0300-9572(00)00210-0. View

18.

Girotra S, Nallamothu B, Spertus J, Li Y, Krumholz H, Chan P . Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012; 367(20):1912-20. PMC: 3517894. DOI: 10.1056/NEJMoa1109148. View

19.

McEvoy M, Field L, Moore H, Smalley J, Nietert P, Scarbrough S . The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest. Resuscitation. 2013; 85(1):82-7. PMC: 3886248. DOI: 10.1016/j.resuscitation.2013.09.019. View

20.

Abella B, Alvarado J, Myklebust H, Edelson D, Barry A, OHearn N . Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA. 2005; 293(3):305-10. DOI: 10.1001/jama.293.3.305. View