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Randomized Controlled Trial
. 2014 Jun;120(6):1339-49, quiz 1349-53.
doi: 10.1097/ALN.0000000000000251.

Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients

William R Hand  1 , Kathryn H Bridges, Marjorie P Stiegler, Randall M Schell, Amy N DiLorenzo, Jesse M Ehrenfeld, Paul J Nietert, Matthew D McEvoy
Affiliations
Randomized Controlled Trial

Effect of a cognitive aid on adherence to perioperative assessment and management guidelines for the cardiac evaluation of noncardiac surgical patients

William R Hand et al. Anesthesiology. 2014 Jun.

Abstract

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.

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Conflict of interest statement

Conflict of Interest: The authors declare no competing interests.

Figures

Appendix 1
Appendix 1
Screenshots from Decision Support Tool
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Screenshots from Decision Support Tool
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Screenshots from Decision Support Tool
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Screenshots from Decision Support Tool
Appendix 1
Appendix 1
Screenshots from Decision Support Tool
Figure 1
Figure 1
Group Assignments Groups A-D were randomly assigned to complete either Quiz 1 or 2 first with or without the decision support tool. Participants in each group subsequently completed the remaining quiz with or without the decision support tool to ensure both quizzes and both testing conditions were evaluable. *One resident from Group C was paged for an emergency during testing. His incomplete results were removed from analysis. DST = decision support tool
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Comment in

  • Learn it-memorize it! Better yet--open your smartphone and use the information!
    Lockman JL, Schwartz AJ. Lockman JL, et al. Anesthesiology. 2014 Jun;120(6):1309-10. doi: 10.1097/ALN.0000000000000250. Anesthesiology. 2014. PMID: 24710218 No abstract available.
  • Old guidelines or methods cannot insure quality or progress.
    Kempen PM. Kempen PM. Anesthesiology. 2015 Jan;122(1):218-9. doi: 10.1097/ALN.0000000000000492. Anesthesiology. 2015. PMID: 25611664 No abstract available.
  • In reply.
    Lockman JL, Schwartz AJ. Lockman JL, et al. Anesthesiology. 2015 Jan;122(1):219-20. doi: 10.1097/ALN.0000000000000493. Anesthesiology. 2015. PMID: 25611665 No abstract available.
  • In reply.
    Hand WR, McEvoy MD. Hand WR, et al. Anesthesiology. 2015 Jan;122(1):220-1. doi: 10.1097/ALN.0000000000000494. Anesthesiology. 2015. PMID: 25611666 No abstract available.

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