Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers

• Published in: Implementation science : IS 2018-03, Vol.13 (1), p.50-50, Article 50
• Main Authors: Alidina, Shehnaz, Goldhaber-Fiebert, Sara N, Hannenberg, Alexander A, Hepner, David L, Singer, Sara J, Neville, Bridget A, Sachetta, James R, Lipsitz, Stuart R, Berry, William R
• Format: Article
• Language: English
• Subjects: Checklist - methods; Clinical Protocols; Cognition; Cognitive aids; Crisis checklists; Cross-Sectional Studies; Decision Support Systems, Clinical; Decision Support Techniques; Emergency manuals; Emergency Treatment - standards; Humans; Implementation of innovations; Operating room crises; Operating Rooms - standards; Organizational context; Patient Care - standards
• ISSN: 1748-5908; 1748-5908
• DOI: 10.1186/s13012-018-0739-4

Operating room (OR) crises are high-acuity events requiring rapid, coordinated management. Medical judgment and decision-making can be compromised in stressful situations, and clinicians may not experience a crisis for many years. A cognitive aid (e.g., checklist) for the most common types of crises in the OR may improve management during unexpected and rare events. While implementation strategies for innovations such as cognitive aids for routine use are becoming better understood, cognitive aids that are rarely used are not yet well understood. We examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. We conducted a cross-sectional study using a Web-based survey of individuals who had downloaded OR cognitive aids from the websites of Ariadne Labs or Stanford University between January 2013 and January 2016. In this paper, we report on the experience of 368 respondents from US hospitals and ambulatory surgical centers. We analyzed the relationship of more successful implementation (measured as reported regular cognitive aid use during applicable clinical events) with organizational context and with participation in a multi-step implementation process. We used multivariable logistic regression to identify significant predictors of reported, regular OR cognitive aid use during OR crises. In the multivariable logistic regression, small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation (p = 0.0092). Completing more implementation steps was also significantly associated with more successful implementation; each implementation step completed was associated with just over 50% higher odds of more successful implementation (p ≤ 0.0001). More successful implementation was associated with leadership support (p