title: Does every code need a "reader?" improvement of rare event management with a cognitive aid "reader" during a simulated emergency: a pilot study.
abstract: BACKGROUND
  Prompt treatment is necessary to assure patient survival during crisis. Obstetric cardiac arrest (OCA) and malignant hyperthermia (MH) are rarely occurring crises. Cognitive aids (CAs) consolidate management and assist treatment decisions. We investigated a novel method to encourage resident physician CA use during simulated crises.
  
  
  METHODS
  Resident physicians were examined during 31 simulated crises of OCA and MH. CAs reviewed in a prior lecture were placed on resuscitation carts. The confederate emergency management team consisted of two anesthesiologists, two critical care nurses, and a medical student who was assigned to act as the CA "Reader." If the subject failed to manage the crisis, the Reader would prompt the subject to use the CA. If the subject still failed to manage the crisis, the Reader would read the aid aloud to the subject. Steps were scored if completed; physiologic variables were recorded. Subject performance was examined before and after Reader introduction.
  
  
  RESULTS
  OCA: No subjects performed all critical steps before introduction of the Reader. Twenty-two percent of Anesthesiology (AN) and 31% of Obstetrics (OB) trainees used the CA. MH: All subjects (AN) correctly diagnosed MH and administered the first dantrolene dose at 7.3 ± 2.5 minutes (PETCO2 72 ± 8 mm Hg, temperature 41.5 °C ± 1.3 °C) but skipped critical treatment steps. Thirty-three percent of subjects used the CA. After Reader introduction, all critical actions for both OCA and MH were completed.
  
  
  CONCLUSIONS
  Reader introduction resulted in execution of all critical actions. During the debriefing of the simulated scenarios, subjects acknowledged the benefit of the Reader.
authors: Department of Anesthesiology, Simulation, Laboratory Division of Academic Affairs, Cooper University, Hospital, Camden, NJ 08103, USA. Burden-Amanda@Cooperhealth.edu
authors: Amanda R
authors: AR
authors: Burden
authors: Zyad J
authors: ZJ
authors: Carr
authors: Gregory W
authors: GW
authors: Staman
authors: Jeffrey J
authors: JJ
authors: Littman
authors: Marc C
authors: MC
authors: Torjman
mesh_terms: D000328:Adult; D003422:Critical Care; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D057209:Hospital Rapid Response Team; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008305:Malignant Hyperthermia / Q000175:diagnosis / Q000188:drug therapy*; D019300:Medical Errors / Q000517:prevention & control; D009774:Obstetrics; D016544:Patient Simulation; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications; D011787:Quality of Health Care; D011932:Reading; D014741:Video Recording