Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, 2650 Ridge Ave, Evanston, IL, 60201, USA.
Grainger Center for Simulation and Innovation, NorthShore University HealthSystem, Evanston, IL, USA.
J Med Syst. 2018 Nov 22;43(1):6. doi: 10.1007/s10916-018-1118-z.
The aim of this study was to assess the effect of a dynamic electronic cognitive aid with embedded clinical decision support (dCA) versus a static cognitive aid (sCA) tool. Anesthesia residents in clinical anesthesia years 2 and 3 were recruited to participate. Each subject was randomized to one of two groups and performed an identical simulated clinical scenario. The primary outcome was task checklist performance with a secondary outcome of performance using the Anesthesia Non-technical skills (ANTS) scoring system. 34 residents were recruited to participate in the study. 19 residents were randomized to the sCA group and 15 to the dCA group. Overall inter-rater agreement for total checklist, malignant hyperthermia, hyperkalemia and ventricular fibrillation was 98.9%, 97.8%, 99.5% and 99.5% respectively with similar Kappa coefficient. Inter-rater agreement for ANTS partial ratings, however, was only 53.5% with a similar Kappa of 0.15. Mean performance was statistically higher in the dCA group versus the sCA group for total check list performance (15.70 ± 1.93 vs 12.95 ± 2.16, p < 0.0001). The difference in performance between dCA and sCA is most notable in dose-dependent related checklist items (4.60 ± 1.3 vs 1.89 ± 1.23, p < 0.0001), while the performance score for dose-independent checklist items was similar between the two groups (p = 0.8908). ANTS ratings did not differ between groups. In conclusion, we evaluated the use of a sCA versus a dCA with embedded decision support in a simulated environment. The dCA group was found to perform more checklist items correctly.Clinical Trial Registration: Clinicaltrials.gov study #: NCT02440607.
本研究旨在评估具有嵌入式临床决策支持的动态电子认知辅助工具（dCA）与静态认知辅助工具（sCA）的效果。招募了临床麻醉学第 2 和第 3 年的麻醉住院医师参与研究。每个受试者被随机分配到两个组中的一个，并执行相同的模拟临床场景。主要结局是任务检查表的表现，次要结局是使用麻醉非技术技能（ANTS）评分系统的表现。 34 名住院医师被招募参与研究。 19 名住院医师被随机分配到 sCA 组，15 名被分配到 dCA 组。总检查表、恶性高热、高钾血症和心室颤动的总体评分者间一致性为 98.9%、97.8%、99.5%和 99.5%，相似的 Kappa 系数分别为 0.98、0.97、0.99 和 0.99。然而，ANTS 部分评分的评分者间一致性仅为 53.5%，相似的 Kappa 系数为 0.15。与 sCA 组相比，dCA 组的总检查表表现（15.70±1.93 对 12.95±2.16，p<0.0001）统计学上更高。在剂量依赖性相关检查表项目中，dCA 和 sCA 之间的表现差异最为显著（4.60±1.3 对 1.89±1.23，p<0.0001），而两组之间的非剂量依赖性检查表项目的表现评分相似（p=0.8908）。两组之间的 ANTS 评分没有差异。总之，我们在模拟环境中评估了 sCA 与嵌入决策支持的 dCA 的使用。发现 dCA 组更正确地执行了更多的检查表项目。 临床试验注册：Clinicaltrials.gov 研究 #: NCT02440607。
