Hock Sara M, Martin Jerome J, Stanfield Stephen C, Alcorn Thomas R, Binstadt Emily S
Emergency Department Rush University Medical Center Chicago Illinois USA.
Emergency Department Regions Hospital Health Partners St Paul Minnesota USA.
AEM Educ Train. 2021 Aug 1;5(4):e10687. doi: 10.1002/aet2.10687. eCollection 2021 Aug.
This study used existing literature and expert feedback to develop and pilot a novel error-avoidance checklist tool for cricothyrotomy in attending physicians. Prior literature has not focused on expert cricothyrotomy performance. While published checklists teach a specific procedural method, ideal for novice learners, this may hinder expert learners.
We endeavored to create a succinct error-avoidance checklist for cricothyrotomy. We hypothesized that such a checklist would prove feasible and acceptable to attending physicians.
This is a multicenter prospective checklist creation, evaluation, and feasibility study. Multiple experts pursued an iterative process to reach consensus on a 7-item error-avoidance checklist. The checklist was trialed for feasibility in pilot sessions at two sites by 45 attending emergency physicians who used the checklist for peer performance assessment and provided feedback.
During the pilot implementation, 94% of respondents completed the procedure within the allotted 120 s. Greater than 85% of respondents agreed that four of the five procedural errors on the checklist were very or somewhat critical to avoid, including cutting >2 cm from midline, creating a false passage, failing to continuously maintain an object in the trachea, and injuring oneself during the procedure. Only 66% of participants felt severing the cricoid cartilage was critical. Successful breath administration and time under 120 s were critical for 100% and 95% of participants, respectively. The checklist was rated "easy" or "very easy" to use by 93% of participants, and 95% found this checklist reasonable for evaluating attending physicians.
We present the multicenter development and implementation of a novel error-avoidance checklist tool for use in expert cricothyrotomy performance. Attending emergency medicine (EM) physicians rated our tool easy to use and agreed that most of the proposed errors were critical. Participants overwhelmingly agreed this tool would be reasonable for evaluation of cricothyrotomy performance among attending EM physicians.
本研究利用现有文献和专家反馈，为主治医师开发并试行一种用于环甲膜切开术的新型差错规避检查表工具。既往文献未聚焦于专家级环甲膜切开术的操作表现。虽然已发表的检查表教授一种特定的操作方法，对新手学习者很理想，但这可能会阻碍专家级学习者。
我们致力于创建一份简洁的环甲膜切开术差错规避检查表。我们假设这样一份检查表对主治医师来说将被证明是可行且可接受的。
这是一项多中心前瞻性检查表创建、评估及可行性研究。多位专家采用迭代过程，就一份包含7项的差错规避检查表达成共识。该检查表在两个地点由45位急诊主治医师进行试点试用，他们使用该检查表进行同行操作评估并提供反馈。
在试点实施期间，94%的受访者在规定的120秒内完成了操作。超过85%的受访者认为检查表上五项操作差错中的四项对于避免差错非常关键或有些关键，包括在距中线>2厘米处切割、造成假道、未能持续保持物体在气管内以及在操作过程中受伤。只有66%的参与者认为切断环状软骨很关键。成功通气和操作时间在120秒以内分别对100%和95%的参与者至关重要。93%的参与者将该检查表评为“容易”或“非常容易”使用，95%的人认为这份检查表用于评估主治医师是合理的。
我们展示了一种用于专家级环甲膜切开术操作的新型差错规避检查表工具的多中心开发和实施。急诊医学（EM）主治医师认为我们的工具易于使用，并同意大多数提出的差错很关键。绝大多数参与者一致认为该工具对于评估急诊医学主治医师的环甲膜切开术操作表现是合理的。
