Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients.
BACKGROUND
The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the standard for perioperative cardiac evaluation. Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested. This research hypothesized that a decision support tool would improve adherence to this consensus guideline.


METHODS
Anesthesiology residents at four training programs participated in an unblinded, prospective, randomized, cross-over trial in which they completed two tests covering clinical scenarios. One quiz was completed from memory and one with the aid of an electronic decision support tool. Performance was evaluated by overall score (% correct), number of incorrect answers with possibly increased cost or risk of care, and the amount of time required to complete the quizzes both with and without the cognitive aid. The primary outcome was the proportion of correct responses attributable to the use of the decision support tool.


RESULTS
All anesthesiology residents at four institutions were recruited and 111 residents participated. Use of the decision support tool resulted in a 25% improvement in adherence to guidelines compared with memory alone (P < 0.0001), and participants made 77% fewer incorrect responses that would have resulted in increased costs. Use of the tool was associated with a 3.4-min increase in time to complete the test (P < 0.001).


CONCLUSIONS
Use of an electronic decision support tool significantly improved adherence to the guidelines as compared with memory alone. The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs.
From the Department of Anesthesia and Perioperative Medicine (W.R.H., K.H.B.) and Department of Public Health Sciences (P.J.N.), Medical University of South Carolina, Charleston, South Carolina; Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (M.P.S.); Department of Anesthesiology, University of Kentucky, Lexington, Kentucky (R.M.S., A.N.D.); Departments of Anesthesiology, Surgery, and Biomedical Informatics (J.M.F.) and Department of Anesthesiology (M.D.M.), Vanderbilt University Medical Center, Nashville, Tennessee.
William R
WR
Hand
Kathryn H
KH
Bridges
Marjorie P
MP
Stiegler
Randall M
RM
Schell
Amy N
AN
DiLorenzo
Jesse M
JM
Ehrenfeld
Paul J
PJ
Nietert
Matthew D
MD
McEvoy
D000776:Anesthesiology / Q000193:education* / Q000379:methods / Q000592:standards*; D003071:Cognition; D018592:Cross-Over Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011300:Preoperative Care / Q000193:education* / Q000379:methods / Q000592:standards*; D011446:Prospective Studies