Impact of a shared decision-making mHealth tool on caregivers' team situational awareness, communication effectiveness, and performance during pediatric cardiopulmonary resuscitation: study protocol of a cluster randomized controlled trial

Abstract

Background: Effective team communication, coordination, and situational awareness (SA) by team members are critical components to deliver optimal cardiopulmonary resuscitation (CPR). Complexity of care during CPR, involvement of numerous providers, miscommunication, and other exogenous factors can all contribute to negatively influencing patient care, thus jeopardizing survival. We aim to investigate whether an mHealth supportive tool (the Interconnected and Focused Mobile Apps on patient Care Environment [InterFACE]) developed as a collaborative platform to support CPR providers in real-time and share patient-centered information would increase SA during pediatric CPR.

Methods: We will conduct a prospective, cluster randomized controlled trial by groups of 6 participants in a tertiary pediatric emergency department (33,000 consultations/year) with pediatric physicians and nurses. We will compare the impact of the InterFACE tool with conventional communication methods on SA and effective team communication during a standardized pediatric in-hospital cardiac arrest and a polytrauma high-fidelity simulations. Forty-eight participants will be randomized (1:1) to consecutively perform two 20-min video-recorded scenarios using either the mHealth tool or conventional methods. The primary endpoint is the SA score, measured with the Situation Awareness Global Assessment Technique (SAGAT) instrument. Enrollment will start in late 2020 and data analysis in early 2021. We anticipate that the intervention will be completed by early 2021 and study results will be submitted in mid 2021 for publication.

Discussion: This clinical trial will assess the impact of a collaborative mHealth tool on increasing situational awareness and effective team communication during in-hospital pediatric resuscitation. As research in this area is scarce, the results generated by this study may become of paramount importance in improving the care of children receiving in-hospital CPR, in the era of increasing communication technology.

Trial registration: ClinicalTrials.gov NCT04464603 . Registered on 9 July 2020.

Keywords: Cardiopulmonary resuscitation; Information technology; Leadership; Mobile device; Pediatrics; Situation awareness; Taskwork; Teamwork.

Fig. 1

The InterFACE mHealth tool to be used during the forthcoming trial. The “Guiding Pad” mobile app installed on a tablet is communicating in real-time patient-centered resuscitation steps on the remote TV screen in the shock room. Informed consent for publication was obtained from the individuals (or their parent/legal) in Fig. 1

Fig. 2

Trial flow chart

Fig. 3

“Guiding Pad” screenshots. Two screenshot examples of the Guiding Pad app. The left-hand side of the screen displays the AHA pediatric advanced life support (PALS) ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) cardiac arrest algorithm. The current step (e.g., determining the shockable status of the arrhythmia) of the resuscitation process is surrounded by a blinking red line. Past actions already accomplished are shown as shaded. At the top right-hand side of the screen, a color-coded title depicts the current step in progress. On the right-hand side of the screen, the sequence of actions to be taken (e.g., to select the right pulseless dysrhythmias under consideration [left screenshot]) are displayed in a stepwise manner to facilitate accurate progression along the algorithm. The current action (e.g., to resume compression and ventilation [right screenshot]) is brought to the attention of the provider by a red-box warning and requires validation by a simple click. Once completed, the next action will be to deliver the weight-based epinephrine dose automatically calculated by the app and then to prepare amiodarone). At the bottom right-hand side, a footer helps to anticipate the next cardiopulmonary resuscitation step. CPR: cardiopulmonary resuscitation; IO: intraosseous; IV: intravenous; PEA: pulseless electrical activity

Fig. 4

InterFACE screenshot of the integrated LCD screen display. The information is displayed in windows that can be flexibly arranged in different layout positions and sizes around the screen, according to user preference. Each window contains patient-centered real-time information, displayed in chronological order and following the systematic ABCDE approach, including vital signs, identified pathology, interventions (procedures, medication received, etc.), as well as resuscitation algorithms. The first section on the left-hand side of the screen displays an entire algorithm overview, thus allowing users to situate the stepwise resuscitation progress in real time along that algorithm. The current step of the resuscitation process is surrounded by a blinking red line that allows an immediate understanding of the current position within the algorithm. Each action already performed turns gray. However, the tool provides the possibility for users to navigate back and forth through the algorithm (or other algorithms) at any time in order to select one of the resuscitation steps if needed. The right-hand side of the screen displays a detailed and clickable list of drug doses and equipment size at user’s disposal and intended as cognitive aids helping with decision making

Fig. 5

AHA pediatric cardiac arrest algorithm – 2018 update [5]