Use of an electronic decision support tool improves management of simulated in-hospital cardiac arrest.
BACKGROUND
Adherence to advanced cardiac life support (ACLS) guidelines during in-hospital cardiac arrest (IHCA) is associated with improved outcomes, but current evidence shows that sub-optimal care is common. Successful execution of such protocols during IHCA requires rapid patient assessment and the performance of a number of ordered, time-sensitive interventions. Accordingly, we sought to determine whether the use of an electronic decision support tool (DST) improves performance during high-fidelity simulations of IHCA.


METHODS
After IRB approval and written informed consent was obtained, 47 senior medical students were enrolled. All participants were ACLS certified and within one month of graduation. Each participant was issued an iPod Touch device with a DST installed that contained all ACLS management algorithms. Participants managed two scenarios of IHCA and were allowed to use the DST in one scenario and prohibited from using it in the other. All participants managed the same scenarios. Simulation sessions were video recorded and graded by trained raters according to previously validated checklists.


RESULTS
Performance of correct protocol steps was significantly greater with the DST than without (84.7% v 73.8%, p<0.001) and participants committed significantly fewer additional errors when using the DST (2.5 errors vs. 3.8 errors, p<0.012).


CONCLUSIONS
Use of an electronic DST provided a significant improvement in the management of simulated IHCA by senior medical students as measured by adherence to published guidelines.
Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: field@musc.edu.
Larry C
LC
Field
Department of Anesthesiology, Vanderbilt University, 2301 Vanderbilt University Hospital, Nashville, TN 37232-7237, United States. Electronic address: matthew.d.mcevoy@vanderbilt.edu.
Matthew D
MD
McEvoy
Department of Orthopedics, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: smalley@musc.edu.
Jeremy C
JC
Smalley
Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: clarca@musc.edu.
Carlee A
CA
Clark
Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: mcevoym@musc.edu.
Michael B
MB
McEvoy
Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: riekeh@musc.edu.
Horst
H
Rieke
Department of Medicine, Division of Biostatistics and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Room 303J, Charleston, SC 29425, United States. Electronic address: nieterpj@musc.edu.
Paul J
PJ
Nietert
Department of Anesthesia & Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, Charleston, SC 29425, United States. Electronic address: furse@musc.edu.
Cory M
CM
Furse
D022561:Advanced Cardiac Life Support; D003198:Computer Simulation; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male
Advanced cardiac life support; Cardiopulmonary arrest; Electronic decision support tool; Simulation