P078: SUCCESSFUL EVIDENCE-BASED INTERNATIONAL EMERGENCY MANUAL IMPLEMENTATION STRATEGY
Kyle Sanchez; Jeffrey Huang, MD; University of Central Florida College of Medicine
Introduction/Background: It is inevitable that healthcare providers will make medical errors. In perioperative situations, a guideline-based response to crises has the potential to positively tip the balance between life and death. It has been suggested that increasing access to resources and decreasing reliance on rote memory are two potential methods to combat medical errors; both of which can be achieved through the use of cognitive aids, such as emergency manuals (EMs). Operating room (OR) EMs are books with a series of medically-established guidelines that detail how healthcare professionals should respond to events. The use of EMs by anestheisologists to guide their performance during non-routine critical events has been shown to reduce errors and maximize productivity. International awareness of the benefits of EM utilization continues to increase, but implementation remains a challenge.
Results: The Anesthesia Patient Safety Foundation (APSF) sponsored a workshop in 2015 where discussion elicited recommendations such as the development of a social media presence of EMs, inclusion of EMs in the pre-surgical timeout, and creation of a public APSF education packet on EMs.
A lack of sufficient training programs on EMs is reported as the greatest barrier to EM usage. Thus, choosing an effective method to train providers on the use of EMs is critical. Since simulation-based medical education is superior to traditional education for teaching other technical skills, participation in EM simulation training events was studied and shown to be associated with an increased routine use of EMs.
Simulation Wars was created in 2017 by the Zhongshan City Society of Anesthesiology as a competition to promote simulation training. A study performed by Huang et al. (2018) one year after the inaugural competition found that EM usage during real critical events significantly increased following a simulation training competition.
Another potential barrier of EM implementation is the cost of distributing EMs in every OR of a hospital. Translated EM were distributed free of charge to anesthesiology departments throughout several hospitals in China in 2018. Huang et al. (2018) showed that these anesthesiologists who received EMs demonstrated higher levels of EM simulation training participation, EM usage during critical events, and self-review of EMs.
Despite the widespread usage of EMs and abundant evidence to support their benefit, there is no standardized protocol for EM usage. Huang et al. (2019) showed that the preferred location for EM placement during critical events is the anesthesia station of the OR and the preferred reader of EMs during critical events is the senior physician. Other parameters related to EM usage should be identified, explored, and standardized to gain a more comprehensive picture.
Conclusion: The use of simulation training was among the first methods shown to facilitate the implementation and usage of EMs. Providing formal EM simulation instructor training may nurture the growth and effectiveness of EM simulation programs. Free distribution of EMs may further enhance implementation. A universal, standardized protocol for EM usage, which specifies parameters such as location of placement and reader role, is critical to support the development and implementation of EMs.