From the *Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois; †NASA Ames Research Center, Moffett Field, California; ‡Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; §Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; and ‖Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Health System, Washington, DC.
Anesth Analg. 2017 Mar;124(3):900-907. doi: 10.1213/ANE.0000000000001746.
Cognitive aids such as checklists are commonly used in modern operating rooms for routine processes, and the use of such aids may be even more important during critical events. The Quality and Safety Committee of the Society for Pediatric Anesthesia (SPA) has developed a set of critical-event checklists and cognitive aids designed for 3 purposes: (1) as a repository of the latest evidence-based and expert opinion-based information to guide response and management of critical events, (2) as a source of just-in-time information during critical events, and (3) as a method to facilitate a shared understanding of required actions among team members during a critical event. Committee members, who represented children's hospitals from across the nation, used the recent literature and established guidelines (where available) and incorporated the expertise of colleagues at their institutions to develop these checklists, which included relevant factors to consider and steps to take in response to critical events. Human factors principles were incorporated to enhance checklist usability, facilitate error-free accomplishment, and ensure a common approach to checklist layout, formatting, structure, and design.The checklists were made available in multiple formats: a PDF version for easy printing, a mobile application, and at some institutions, a Web-based application using the anesthesia information management system. After the checklists were created, training commenced, and plans for validation were begun. User training is essential for successful implementation and should ideally include explanation of the organization of the checklists; familiarization of users with the layout, structure, and formatting of the checklists; coaching in how to use the checklists in a team environment; reviewing of the items; and simulation of checklist use. Because of the rare and unpredictable nature of critical events, clinical trials that use crisis checklists are difficult to conduct; however, recent and future simulation studies with adult checklists provide a promising avenue for future validation of the SPA checklists. This article will review the developmental steps in producing the SPA crisis checklists, including creation of content, incorporation of human factors elements, and validation in simulation. Critical-events checklists have the potential to improve patient care during emergency events, and it is hoped that incorporating the elements presented in this article will aid in successful implementation of these essential cognitive aids.
认知辅助工具，如清单，常用于现代手术室的常规流程，在关键事件中使用这些辅助工具可能更为重要。小儿麻醉学会（SPA）质量与安全委员会开发了一套关键事件清单和认知辅助工具，旨在实现以下 3 个目的：（1）作为最新基于证据和专家意见的信息库，以指导关键事件的应对和管理；（2）作为关键事件中即时信息的来源；（3）作为一种方法，便于在关键事件中团队成员之间对所需行动达成共识。委员会成员代表来自全国各地儿童医院，他们使用了最新文献和既定指南（如有），并整合了所在机构同事的专业知识来制定这些清单，其中包括应对关键事件时需要考虑的相关因素和采取的步骤。清单的制定融入了人为因素原则，以提高清单的可用性、实现无差错完成，并确保清单布局、格式、结构和设计的通用方法。这些清单以多种格式提供：便于打印的 PDF 版本、移动应用程序，以及在一些机构，使用麻醉信息管理系统的基于 Web 的应用程序。清单创建完成后，随即开始进行培训，并开始制定验证计划。用户培训对于成功实施至关重要，理想情况下应包括：解释清单的组织；用户熟悉清单的布局、结构和格式；在团队环境中使用清单的指导；清单项目的复习；以及清单使用的模拟。由于关键事件罕见且不可预测，因此使用危机清单进行临床试验较为困难；然而，成人清单的近期和未来模拟研究为 SPA 清单的未来验证提供了有前景的途径。本文将回顾 SPA 危机清单制定的发展步骤，包括内容创建、人为因素元素的融入，以及模拟验证。关键事件清单有可能改善紧急事件期间的患者护理，希望本文介绍的元素能够帮助成功实施这些重要的认知辅助工具。
