title: A randomised controlled trial of cognitive aids for emergency airway equipment preparation in a Paediatric Emergency Department.
abstract: BACKGROUND
  Safety of emergency intubation may be improved by standardising equipment preparation; the efficacy of cognitive aids is unknown.
  
  
  METHODS
  This randomised controlled trial compared no cognitive aid (control) with the use of a checklist or picture template for emergency airway equipment preparation in the Emergency Department of The Royal Children's Hospital, Melbourne.
  
  
  RESULTS
  Sixty-three participants were recruited, 21 randomised to each group. Equal numbers of nursing, junior medical, and senior medical staff were included in each group. Compared to controls, the checklist or template group had significantly lower equipment omission rates (median 30% IQR 20-40% control, median 10% IQR 5-10 % checklist, median 10% IQR 5-20% template; p < 0.05). The combined omission rate and sizing error rate was lower using a checklist or template (median 35 % IQR 30-45 % control, median 15% IQR 10-20% checklist, median 15% IQR 10-30% template; p < 0.05). The template group had less variation in equipment location compared to checklist or controls. There was no significant difference in preparation time in controls (mean 3 min 14 s sd 56 s) compared to checklist (mean 3 min 46 s sd 1 min 15 s) or template (mean 3 min 6 s sd 49 s; p = 0.06).
  
  
  CONCLUSIONS
  Template use reduces variation in airway equipment location during preparation foremergency intubation, with an equivalent reduction in equipment omission rate to the use of a checklist. The use of a template for equipment preparation and a checklist for team, patient, and monitoring preparation may provide the best combination of both cognitive aids.
  
  
  CONCLUSIONS
  The use of a cognitive aid for emergency airway equipment preparation reduces errors of omission. Template utilisation reduces variation in equipment location.
  
  
  BACKGROUND
  Australian and New Zealand Trials Registry (ACTRN12615000541505).
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. Elliot.long@rch.org.au.|Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Australia. Elliot.long@rch.org.au.|Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC, Australia. Elliot.long@rch.org.au.
authors.forename: Elliot
authors.initials: E
authors.lastname: Long
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. patrick.fitzpatrick@rch.org.au.|Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Australia. patrick.fitzpatrick@rch.org.au.
authors.forename: Patrick
authors.initials: P
authors.lastname: Fitzpatrick
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. domenic.concotta@rch.org.au.|Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Australia. domenic.concotta@rch.org.au.|Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC, Australia. domenic.concotta@rch.org.au.
authors.forename: Domenic R
authors.initials: DR
authors.lastname: Cincotta
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. joanne.grindlay@rch.org.au.|Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Australia. joanne.grindlay@rch.org.au.|Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, VIC, Australia. joanne.grindlay@rch.org.au.
authors.forename: Joanne
authors.initials: J
authors.lastname: Grindlay
authors.affiliation: Department of Emergency Medicine, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. michael.barrett@olchc.ie.|Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Australia. michael.barrett@olchc.ie.|Paediatric Emergency Research Unit, National Children's Research Centre, Crumlin, Dublin, Ireland. michael.barrett@olchc.ie.
authors.forename: Michael Joseph
authors.initials: MJ
authors.lastname: Barrett
mesh_terms: D058109:Airway Management / Q000295:instrumentation*; D057189:Checklist; D003660:Decision Support Systems, Management; D004636:Emergency Service, Hospital; D004864:Equipment and Supplies; D005260:Female; D006801:Humans; D008297:Male; D061214:Patient Safety / Q000592:standards*; D014739:Victoria
references.citation: Pediatr Crit Care Med. 2010 May;11(3):343-8
references.pmid: 20464775
references.citation: Paediatr Anaesth. 2014 Dec;24(12):1204-11
references.pmid: 25039321
references.citation: Emerg Med J. 2011 Mar;28(3):217-20
references.pmid: 21149865
references.citation: Anaesthesia. 2000 May;55(5):485-8
references.pmid: 10792145
references.citation: Ann Emerg Med. 2012 Sep;60(3):251-9
references.pmid: 22424653
references.citation: Emerg Med J. 2009 Mar;26(3):230
references.pmid: 19234033
references.citation: Anaesthesia. 2014 Jul;69(7):669-77
references.pmid: 24917333
references.citation: J Trauma Acute Care Surg. 2012 Dec;73(6):1401-5
references.pmid: 23188232
references.citation: J Intensive Care Med. 2011 Jan-Feb;26(1):50-6
references.pmid: 21262753
references.citation: J Intensive Care Med. 2007 May-Jun;22(3):157-65
references.pmid: 17562739
references.citation: Crit Care Med. 2013 Mar;41(3):874-85
references.pmid: 23328260
references.citation: J Emerg Med. 2011 Oct;41(4):347-54
references.pmid: 20434289
references.citation: Paediatr Anaesth. 2003 Sep;13(7):589-95
references.pmid: 12950859
references.citation: BMC Med Res Methodol. 2007 Jul 03;7:30
references.pmid: 17608932
references.citation: J Intensive Care Med. 2007 Jul-Aug;22(4):208-15
references.pmid: 17712056
references.citation: Br J Anaesth. 2011 May;106(5):632-42
references.pmid: 21447489
references.citation: Emerg Med Australas. 2011 Aug;23(4):400-2
references.pmid: 21824296
references.citation: Acad Emerg Med. 2015 Aug;22(8):989-92
references.pmid: 26194607
references.citation: Anesthesiology. 1995 Feb;82(2):367-76
references.pmid: 7856895
references.citation: Resuscitation. 2013 Nov;84(11):1500-4
references.pmid: 23911630
references.citation: Intensive Care Med. 2010 Feb;36(2):248-55
references.pmid: 19921148
references.citation: Acta Anaesthesiol Scand. 2010 Nov;54(10):1179-84
references.pmid: 21069898
references.citation: Br J Anaesth. 2014 Aug;113(2):211-9
references.pmid: 25038153
references.citation: Scand J Trauma Resusc Emerg Med. 2014 Sep 11;22:41
references.pmid: 25209044