Evidence map›Paper›PMID 37003046›Full record

Observational studyJournal of clinical anesthesia2023

Emergency manual peri-crisis use six years following implementation: Sustainment of an intervention for rare crises.

Sara N Goldhaber-Fiebert, Anna Frackman, Aalok V Agarwala, Allison Doney, May C M Pian-Smith

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Journal of clinical anesthesia, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
1.7field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Sara N Goldhaber-FiebertDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Dr. Rm H3674, Stanford, CA 94305, USA. Electronic address: saragf@stanford.edu.
Anna FrackmanDepartment of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Dr. Rm H3674, Stanford, CA 94305, USA. Electronic address: Afrackma@stanford.edu.
Aalok V AgarwalaDepartment of Anesthesia, Massachusetts Eye and Ear Institute, 243 Charles Street, Boston, MA 02114, USA. Electronic address: Aalok_Agarwala@meei.harvard.edu.
Allison DoneyDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: ALemovitz@mgh.harvard.edu.
May C M Pian-SmithDepartment of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: MPianSmith@mgh.harvard.edu.
Massachusetts General Hospital · USStanford University · USMassachusetts Eye and Ear Infirmary · US

Funding

Stanford Center for Clinical & Translational Education and Research (Spectrum)UL1TR003142 · NCATS · STANFORD UNIVERSITY · PI O'HARA, RUTH M · 2019 to 2023
$45.0M
NCATS NIH HHS UL1 TR003142
6 · The paper itself

Abstract

STUDY

objectiveUse of cognitive aids during emergencies increases key actions and decreases omissions, both known to save lives. With little known about emergency manual (EM) clinical use, we aimed to help answer "Will EMs be used peri-crisis at a meaningful frequency?" and to explore clinical sustainment.

designProspective, observational study.

settingOperating Rooms. PATIENTS: All patients undergoing anesthesia at a major academic medical center during the study periods; ∼75,000 cases. INTERVENTION & MEASUREMENTS: To understand the initial and sustainment phases of EM implementation, we placed a question regarding EM use at the end of every anesthetic case to prospectively measure EM use at: implementation, one-year later, and six years post-implementation. MAIN

resultsFor more than twenty-four thousand cases in each approximately 6-month study period, EMs were used peri-crisis (before, during or after a perioperative crisis) in 145 cases initially (0.55%; SE 0.045%), 42 cases one-year later (0.17%; SE 0.026%), and 57 cases (0.21%; SE 0.028%) six years post-implementation. Peri-crisis EM uses dropped 0.38% (97.5% CI: 0.26%, 0.49%) from initial to one-year post-implementation. After that, peri-crisis EM uses did not differ significantly from one-year to six years post-implementation, showing sustainment [increased 0.04% (97.5% CI: -0.05%, 0.12%)]. Among cases with cardiac arrest or CPR, as a subset proxy for relevant crises, EMs were used in 7/13 such cases initially (54%, SE 13.6%), 8/20 one-year later (40%; SE 10.9%) and 7/13 six years later (54%; SE 13.6%).

conclusionsAfter an initial expected drop, EM peri-crisis use six years post-implementation was: sustained without intensive additional efforts, averaged ∼10 times per month at a single institution, and was reported in more than half of cases with cardiac arrest or CPR. Peri-crisis use of EMs is appropriately rare, though for relevant crises can have substantial positive impacts as described in prior literature. The sustained use of EMs may be related to increasing cultural acceptance of EMs, as reflected in survey result trends and broader cognitive aid literature.

Indexed as

Emergency Medical ServicesHeart ArrestHumansOperating RoomsProspective StudiesSurveys and QuestionnairesCognitive aidCrisis checklistEmergency manualImplementation scienceIntraoperative emergencyPerioperative crisesSustainment

Identifiers

PMID37003046
PMCPMC11669371
OpenAlexW4362458801

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.