The Impact of a Displayed Checklist on Simulated Pediatric Trauma Resuscitations
Erin Hulfish1, Glenn Stryjewski2, Megan Feick3, Maricar Diaz4
1Stony Brook Children's Hospital, Stony Brook, NY;2Alaska Native Medical Center, Anchorage, AK;3Thomas Jefferson University, Philadelphia, PA;4Nemours/Alfred I duPont Hospital, Wilmington, DE
Background: ATLS resuscitation follows a strict protocolized approach to the initial trauma evaluation. Despite this structure, elements of the primary and secondary assessments can still be omitted. These omissions may have negative consequences on patient outcomes. The aim of this study is to determine if a cognitive aid checklist reduces omissions and speeds the time to assessment completion. We additionally investigated if a displayed checklist improved performance further.
Methods: A series of 130 simulated trauma resuscitations were performed. Teams were randomized to one of three arms (no checklist, handheld checklist, or displayed). Primary and secondary surveys were video recorded. These were then analyzed to determine completion of tasks of the primary survey (19 tasks) and secondary survey (15 tasks). Time to completion of surveys was also recorded.
Results: There was no difference in time to completion of surveys among the three arms. In the primary survey there was a non-significant increase in the number of completed tasks with the use of a handheld and displayed checklist as compared to no checklist. In the secondary survey, there was a significant improvement in task completion with the handheld (p=0.033) and displayed (p=0.0002) checklists.
Conclusions: Despite a structured approach to trauma resuscitations, omissions still occur. The use of a cognitive aid checklist improves performance of the primary survey and reduces omissions in the secondary survey. A displayed checklist appears most effective. Use of this additional tool neither accelerates nor delays survey completion. Better compliance with ATLS protocols may improve patient outcomes.
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