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Development of Obstetric Anesthesia Cognitive Aids
Abstract Number: F-45
Abstract Type: Original Research
Cognitive aids are checklists, guidelines or protocols created to assist users performing certain tasks. The goal is to decrease errors and reduce time taken to complete a set of actions. Medicine has adapted checklists into standard practice, i.e. preoperative time out and surgical safety checklists. Studies have shown the utility of cognitive aids in emergencies with more essential tasks completed when checklists were available.1 In obstetrics there is a constant possibility of acute, life threatening emergencies. The development of well-designed, peer reviewed cognitive aids for obstetric anesthetic emergencies may allow the practitioner to follow best practice guidelines efficiently.
The aim of this project was to develop a peer reviewed collection of cognitive aids for obstetric anesthesia emergencies. Crisis topics were developed through literature review and agreed upon by consensus. Figure 1 shows a cognitive aid developed for maternal code. Cognitive aids were designed using the Stanford AIM Lab emergency cognitive aid design specifications which were developed for use in the Stanford Emergency Manual.2 The design approach for static paper-based aids was adapted from the Rapid-Read: step-at-a-glance approach previously described for dynamic computer-based aids.3 An object-action structure was implemented to describe checklist action and cognitive steps with the aim to facilitate faster aid usage and knowledge retrieval. Human factors usability testing was completed on our cognitive aid pictographic design for ACLS. Participants obtained drug dosing information 35% faster (p=0.003) and rhythm information 44% faster (p=0.002) when using a pictographic design compared with a text-based design. This collection of pictographic aids will be collated into an obstetric anesthesia emergency manual that can be used for the management of common and uncommon events on L&D units.
Over the next year, the Obstetric Anesthesia Cognitive Aid Emergency Manual will be developed and designed to provide high yield information. We anticipate the manual will be used as a tool in obstetric emergencies and for non-emergency teaching and review. Effective utilization of emergency cognitive aids requires a multidisciplinary approach and will be studied with high fidelity simulation.4
1. N Engl J Med. 2013:368(3):246–253
3. Pervasive Health 2014: 25-32
4. Anesthesiology. 2014;120(4):801-806