Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, Ostmerheimer Str. 200, 51429, Cologne, Germany.
Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.
Scand J Trauma Resusc Emerg Med. 2023 Nov 17;31(1):81. doi: 10.1186/s13049-023-01144-3.
Checklists are a powerful tool for reduction of mortality and morbidity. Checklists structure complex processes in a reproducible manner, optimize team interaction, and prevent errors related to human factors. Despite wide dissemination of the checklist, effects of checklist use in the prehospital emergency medicine are currently unclear. The aim of the study was to demonstrate that participants achieve higher adherence to guideline-recommended actions, manage the scenario more time-efficient, and thirdly demonstrate better adherence to the ABCDE-compliant workflow in a simulated ROSC situation.
CHIPS was a prospective randomized case-control study. Professional emergency medical service teams were asked to perform cardiopulmonary resuscitation on an adult high-fidelity patient simulator achieving ROSC. The intervention group used a checklist which transferred the ERC guideline statements of ROSC into the structure of the 'ABCDE' mnemonic. Guideline adherence (performance score, PS), utilization of process time (items/minute) and workflow were measured by analyzing continuous A/V recordings of the simulation. Pre- and post-questionnaires addressing demographics and relevance of the checklist were recorded. Effect sizes were determined by calculating Cohen's d. The level of significance was defined at p < 0.05.
Twenty scenarios in the intervention group (INT) and twenty-one in the control group (CON) were evaluated. The average time of use of the checklist (CU) in the INT was 6.32 min (2.39-9.18 min; SD = 2.08 min). Mean PS of INT was significantly higher than CON, with a strong effect size (p = 0.001, d = 0.935). In the INT, significantly more items were completed per minute of scenario duration (INT, 1.48 items/min; CON, 1.15 items/min, difference: 0.33/min (25%), p = 0.001), showing a large effect size (d = 1.11). The workflow did not significantly differ between the groups (p = 0.079), although a medium effect size was shown (d = 0.563) with the tendency of the CON group deviating stronger from the ABCDE than the INT.
Checklists can have positive effects on outcome in the prehospital setting by significantly facilitates adherence to guidelines. Checklist use may be time-effective in the prehospital setting. Checklists based on the 'ABCDE' mnemonic can be used according to the 'do verify' approach. Team Time Outs are recommended to start and finish checklists.
清单是降低死亡率和发病率的有力工具。清单以可重复的方式构建复杂的流程，优化团队协作，并防止与人为因素相关的错误。尽管清单已广泛传播，但目前尚不清楚清单在院前急救医学中的使用效果。本研究旨在证明参与者在推荐的操作指南方面具有更高的依从性，更有效地管理场景，并且在模拟的 ROSC 情况下，第三，更好地遵守 ABCDE 合规工作流程。
CHIPS 是一项前瞻性随机病例对照研究。要求专业的紧急医疗服务团队对成人高保真患者模拟器进行心肺复苏，以达到 ROSC。干预组使用了一份清单，该清单将 ERC 复苏指南中的陈述转化为“ABCDE”助记符的结构。通过分析模拟的连续 A/V 记录来测量指南的依从性（表现评分，PS）、使用过程时间（项目/分钟）和工作流程。记录了针对人口统计学和清单相关性的预和后调查问卷。通过计算 Cohen 的 d 来确定效应量。显著性水平定义为 p<0.05。
干预组（INT）评估了 20 个场景，对照组（CON）评估了 21 个场景。INT 中清单的平均使用时间（CU）为 6.32 分钟（2.39-9.18 分钟；SD=2.08 分钟）。INT 的平均 PS 明显高于 CON，具有很强的效应量（p=0.001，d=0.935）。在 INT 中，每分钟场景持续时间完成的项目明显更多（INT，1.48 个/分钟；CON，1.15 个/分钟，差异：0.33/分钟（25%），p=0.001），具有较大的效应量（d=1.11）。虽然显示出中等效应量（d=0.563），但 CON 组明显偏离 ABCDE 的趋势强于 INT 组，但两组之间的工作流程没有显著差异（p=0.079）。
清单可以通过显著提高对指南的依从性，对院前环境中的结果产生积极影响。清单的使用在院前环境中可能是有效的。基于“ABCDE”助记符的清单可以根据“做验证”方法使用。建议使用团队时间休息来启动和完成清单。
