Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients. Anesthesiology 2014 Jun;120(6):1339-49, quiz 1349-53
Date
04/08/2014Pubmed ID
24705442Pubmed Central ID
PMC4108481DOI
10.1097/ALN.0000000000000251Scopus ID
2-s2.0-84901634194 (requires institutional sign-in at Scopus site) 25 CitationsAbstract
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.
Author List
Hand WR, Bridges KH, Stiegler MP, Schell RM, DiLorenzo AN, Ehrenfeld JM, Nietert PJ, McEvoy MDAuthor
Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AnesthesiologyCognition
Cross-Over Studies
Disease Management
Female
Humans
Internship and Residency
Male
Practice Guidelines as Topic
Preoperative Care
Prospective Studies
