Kazior Michael R, Wang Jacob, Stiegler Marjorie P, Nguyen Dung, Rebel Annette, Isaak Robert S
J Educ Perioper Med. 2017 Jul 1;19(3):E608. eCollection 2017 Jul-Sep.
Emergency manuals, which are safety essentials in non-medical high-reliability organizations (e.g., aviation), have recently gained acceptance in critical medical environments. Of the existing emergency manuals in anesthesiology, most are geared towards intraoperative settings. Additionally, most evidence supporting their efficacy focuses on the study of physicians with at least some meaningful experience as a physician. Our aim was to evaluate whether an emergency manual would improve the performance of novice physicians (post-graduate year [PGY] 1 or first year resident) in managing a critical event in the intensive care unit (ICU).
PGY1 interns (n=41) were assessed on the management of a simulated critical event (unstable bradycardia) in the ICU. Participants underwent a group allocation process to either a control group (n=18) or an intervention group (emergency manual provided, n=23). The number of successfully executed treatment and diagnostic interventions completed was evaluated over a ten minute (600 seconds) simulation for each participant.
The participants using the emergency manual averaged 9.9/12 (83%) interventions, compared to an average of 7.1/12 (59%) interventions (p < 0.01) in the control group.
The use of an emergency manual was associated with a significant improvement in critical event management by individual novice physicians in a simulated ICU patient (23% average increase).
应急手册是航空等非医疗高可靠性组织中的安全必备品，最近在关键医疗环境中也得到了认可。在现有的麻醉学应急手册中，大多数是针对术中情况的。此外，大多数支持其有效性的证据都集中在对至少有一定医生经验的医生的研究上。我们的目的是评估应急手册是否能提高新手医生（研究生一年级[PGY]或第一年住院医生）在重症监护病房（ICU）处理危急事件的能力。
对41名PGY1实习生在ICU模拟危急事件（不稳定心动过缓）的处理情况进行评估。参与者经过分组过程，分为对照组（n = 18）或干预组（提供应急手册，n = 23）。在10分钟（600秒）的模拟过程中，评估每个参与者成功执行的治疗和诊断干预措施的数量。
使用应急手册的参与者平均完成了9.9/12（83%）项干预措施，而对照组平均完成了7.1/12（59%）项干预措施（p < 0.01）。
在模拟的ICU患者中，使用应急手册与新手医生在危急事件处理方面的显著改善相关（平均提高23%）。
