认知辅助是否能降低复苏团队表现中的错误率？澳大利亚的急诊医学方案模拟训练试验（TEMPIST）。
Do cognitive aids reduce error rates in resuscitation team performance? Trial of emergency medicine protocols in simulation training (TEMPIST) in Australia.
机构信息
University Centre for Rural Health, School of Medicine, Western Sydney University, 62 Uralba Street, Lismore, NSW, 2480, Australia.
Maclean District Hospital, Maclean, NSW, Australia.
出版信息
Hum Resour Health. 2020 Jan 8;18(1):1. doi: 10.1186/s12960-019-0441-x.
BACKGROUND
Resuscitation of patients with time-critical and life-threatening illness represents a cognitive challenge for emergency room (ER) clinicians. We designed a cognitive aid, the Emergency Protocols Handbook, to simplify clinical management and team processes. Resuscitation guidelines were reformatted into simple, single step-by-step pathways. This Australian randomised controlled trial tested the effectiveness of this cognitive aid in a simulated ER environment by observing team error rates when current resuscitation guidelines were followed, with and without the handbook.
METHODS
Resuscitation teams were randomised to manage two scenarios with the handbook and two without in a high-fidelity simulation centre. Each scenario was video-recorded. The primary outcome measure was error rates (the number of errors made out of 15 key tasks per scenario). Key tasks varied by scenario. Each team completed four scenarios and was measured on 60 key tasks. Participants were surveyed regarding their perception of the usefulness of the handbook.
RESULTS
Twenty-one groups performed 84 ER crisis simulations. The unadjusted error rate in the handbook group was 18.8% (121/645) versus 38.9% (239/615) in the non-handbook group. There was a statistically significant reduction of 54.0% (95% CI 49.9-57.9) in the estimated percentage error rate when the handbook was available across all scenarios 17.9% (95% CI 14.4-22.0%) versus 38.9% (95% CI 34.2-43.9%). Almost all (97%) participants said they would want to use this cognitive aid during a real medical crisis situation.
CONCLUSION
This trial showed that by following the step-by-step, linear pathways in the handbook, clinicians more than halved their teams' rate of error, across four simulated medical crises. The handbook improves team performance and enables healthcare teams to reduce clinical error rates and thus reduce harm for patients.
TRIAL REGISTRATION
ACTRN12616001456448 registered: www.anzctr.org.au. Trial site: http://emergencyprotocols.org.au/.
背景
对于急诊室（ER）临床医生来说，抢救时间紧迫和危及生命的患者是一项认知挑战。我们设计了一种认知辅助工具，即《急救预案手册》，以简化临床管理和团队流程。复苏指南被重新制定为简单的单步骤流程。这项澳大利亚的随机对照试验通过观察在模拟 ER 环境中遵循当前复苏指南时团队的错误率，测试了这种认知辅助工具的有效性，方法是使用和不使用手册。
方法
复苏团队被随机分配在高保真模拟中心使用手册管理两个场景和不使用手册管理两个场景。每个场景都进行了视频录制。主要观察指标是错误率（每个场景 15 个关键任务中的错误数）。关键任务因场景而异。每个团队完成四个场景，共完成 60 个关键任务。参与者被调查了他们对手册有用性的看法。
结果
21 个小组进行了 84 次 ER 危机模拟。在手册组中的未调整的错误率为 18.8%（121/645），而在非手册组中的错误率为 38.9%（239/615）。当手册在所有场景中都可用时，错误率估计百分比有统计学显著降低 54.0%（95%CI 49.9-57.9），从 17.9%（95%CI 14.4-22.0%）降至 38.9%（95%CI 34.2-43.9%）。几乎所有（97%）参与者表示，他们在真正的医疗危机情况下都希望使用这种认知辅助工具。
结论
这项试验表明，通过遵循手册中的逐步、线性路径，临床医生将团队的错误率降低了一半以上，涉及四个模拟医疗危机。该手册提高了团队绩效，使医疗团队能够降低临床错误率，从而减少患者的伤害。
试验注册
ACTRN12616001456448，注册于 www.anzctr.org.au。试验地点：http://emergencyprotocols.org.au/。
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