From the NorthShore University HealthSystem (S.B.G., N.B-I., J.C., C.W., C.G.), Evanston, IL; University of Chicago Pritzker School of Medicine (S.B.G.), Chicago, IL; University of Arizona College of Medicine (S.B.), Tucson, AZ; The Mayo Clinic College of Medicine and Science (T.F.D.), Rochester, MN; and Harvard Medical School (F.S.), Boston, MA.
Simul Healthc. 2024 Oct 1;19(5):281-286. doi: 10.1097/SIH.0000000000000749. Epub 2023 Sep 21.
Combining audiovisual decision support during perioperative critical events might enhance provider diagnostic and therapeutic accuracy and efficiency.
This study is a prospective, randomized controlled pilot trial studying the impact of audiovisual decision support on anesthesia professional performance at NorthShore University HealthSystem's high fidelity simulation center. Twenty anesthesia professionals (>2 years of clinical experience in the current role) were randomized to 2 groups (current care model vs. audiovisual assistance) and underwent 3 periprocedural simulation scenarios, where patient deterioration occurs: anaphylaxis, amniotic fluid embolism, and cardiac arrest during dental case.
Overall, there was a statistically significant decrease in the mean and median pooled times to diagnosis in both the amniotic fluid embolism and pediatric dental scenarios. There was a statistically significant increase in the number of participants in the intervention group who made diagnosis 3 before the end of the scene ( P = 0.03) in the amniotic fluid embolism case. In the pediatric dental case, there was a statistically significant reduction in the median time to diagnosis 1 and diagnosis 3 in the intervention group versus control ( P = 0.01 and P = 0.0002). A significant increase in the number of participants in the intervention group versus control made the correct diagnosis 2 before vital sign change 3 ( P = 0.03), and more participants in the intervention group made the correct diagnosis 3 before the end of the scene when compared with control ( P = 0.001). The median time to start intervention 2 during the dental case was statistically significantly greater in the intervention group versus the control ( P = 0.05). All other endpoints were not statistically significant among the 3 simulation scenarios. Six questions were answered by all participants upon immediate completion of the simulation scenarios and revealed that 19 of 20 participants had delivered anesthesia care to patients similar to the 3 simulation scenarios and 18 of 20 participants reported that they would prefer audiovisual assistance to detect abnormalities in vital signs that subsequently provides appropriate diagnostic and therapeutic options.
This pilot study suggested some significant improvement in anesthesia professional time to correct diagnosis and completion of identification of the correct diagnosis before the next vital change in the audiovisual cue group versus control, particularly in the outpatient dental case. In addition, the mean and median pooled times to diagnosis were significantly reduced by approximately 1 minute in both evaluated simulation scenarios. The postsimulation survey responses also suggest the desirability of an audiovisual decision support tool among the current anesthesia professional participants. However, overall, there were no significant differences in the time to intervention between groups in all simulation scenarios.
在围手术期关键事件中结合视听决策支持可能会提高提供者的诊断和治疗准确性和效率。
本研究是一项前瞻性、随机对照的初步试验，研究了视听决策支持对北岸大学健康系统高保真模拟中心麻醉专业人员绩效的影响。20 名麻醉专业人员（在当前角色中具有>2 年的临床经验）被随机分为 2 组（当前护理模式与视听辅助），并进行了 3 个围手术期模拟场景，患者出现恶化：过敏反应、羊水栓塞和牙科病例中心脏骤停。
总体而言，在羊水栓塞和儿科牙科场景中，平均和中位数的诊断时间都有统计学意义的减少。在干预组中，有更多的参与者在羊水栓塞病例中在场景结束前做出诊断 3（P = 0.03）。在儿科牙科病例中，与对照组相比，干预组的诊断 1 和诊断 3 的中位数时间显著减少（P = 0.01 和 P = 0.0002）。干预组与对照组相比，在生命体征变化 3 之前做出正确诊断 2 的参与者数量显著增加（P = 0.03），并且当与对照组相比时，干预组中更多的参与者在场景结束前做出正确诊断 3（P = 0.001）。在牙科病例中，干预组与对照组相比，干预 2 的中位时间明显更长（P = 0.05）。在 3 个模拟场景中，所有其他终点均无统计学意义。所有 20 名参与者在模拟场景完成后立即回答了 6 个问题，结果显示，20 名参与者中有 19 名曾为与 3 个模拟场景相似的患者提供过麻醉护理，18 名参与者表示他们更愿意使用视听辅助来检测生命体征异常，从而提供适当的诊断和治疗选择。
这项初步研究表明，在视听线索组与对照组相比，麻醉专业人员在正确诊断的时间和在生命体征发生下一次变化之前完成正确诊断的识别方面有所改善，特别是在门诊牙科病例中。此外，在两个评估的模拟场景中，诊断的平均和中位数时间都显著减少了大约 1 分钟。模拟后调查的回应也表明了当前麻醉专业人员参与者对视听决策支持工具的需求。然而，总体而言，在所有模拟场景中，干预组之间的干预时间没有显著差异。
