背景:清单是降低死亡率和发病率的有力工具。检查表以可重复的方式结构复杂的过程,优化团队互动,并防止与人为因素有关的错误。尽管清单广泛传播,目前尚不清楚在院前急诊医学中使用清单的效果。该研究的目的是证明参与者对指南建议的行动有更高的依从性,管理场景更省时,第三,在模拟的ROSC情况下,证明更好地遵守符合ABCDE的工作流程。
方法:CHIPS是一项前瞻性随机病例对照研究。要求专业的紧急医疗服务团队在成人高保真患者模拟器上进行心肺复苏,以实现ROSC。干预组使用了一份清单,将ROSC的ERC指南陈述转移到“ABCDE”助记符的结构中。指导方针依从性(绩效评分,PS),通过分析模拟的连续A/V记录来测量过程时间(项目/分钟)和工作流程的利用率。记录了有关人口统计和清单相关性的问卷调查前后。通过计算Cohen'sd来确定效应大小。显著性水平定义为p<0.05。
结果:评估了干预组(INT)的20种情况和对照组(CON)的21种情况。在INT中使用检查表(CU)的平均时间为6.32分钟(2.39-9.18分钟;SD=2.08分钟)。INT的平均PS显著高于CON,具有较强的效应大小(p=0.001,d=0.935)。在INT,场景持续时间的每分钟完成更多的项目(INT,1.48项目/分钟;CON,1.15项目/分钟,差异:0.33/min(25%),p=0.001),显示较大的效应大小(d=1.11)。两组之间的工作流程没有显着差异(p=0.079),尽管显示出中等效应大小(d=0.563),CON组与ABCDE的偏离趋势比INT强。
结论:检查清单可以显著促进对指南的遵守,从而对院前环境的预后产生积极影响。在院前设置中,检查表的使用可能是时间有效的。可根据“确认”方法使用基于“ABCDE”助记符的检查表。建议开始和完成检查表。
BACKGROUND: Checklists are a powerful tool for reduction of mortality and morbidity.
Checklists structure complex processes in a reproducible manner, optimize team interaction, and prevent errors related to human factors. Despite wide dissemination of the checklist, effects of checklist use in the prehospital emergency medicine are currently unclear. The aim of the study was to demonstrate that participants achieve higher adherence to guideline-recommended actions, manage the scenario more time-efficient, and thirdly demonstrate better adherence to the ABCDE-compliant workflow in a simulated ROSC situation.
METHODS: CHIPS was a prospective randomized case-control study. Professional emergency medical service teams were asked to perform cardiopulmonary resuscitation on an adult high-fidelity patient simulator achieving ROSC. The intervention group used a checklist which transferred the ERC guideline statements of ROSC into the structure of the \'ABCDE\' mnemonic. Guideline adherence (performance score, PS), utilization of process time (items/minute) and workflow were measured by analyzing continuous A/V recordings of the simulation. Pre- and post-questionnaires addressing demographics and relevance of the checklist were recorded. Effect sizes were determined by calculating Cohen\'s d. The level of significance was defined at p < 0.05.
RESULTS: Twenty scenarios in the intervention group (INT) and twenty-one in the control group (CON) were evaluated. The average time of use of the checklist (CU) in the INT was 6.32 min (2.39-9.18 min; SD = 2.08 min). Mean PS of INT was significantly higher than CON, with a strong effect size (p = 0.001, d = 0.935). In the INT, significantly more items were completed per minute of scenario duration (INT, 1.48 items/min; CON, 1.15 items/min, difference: 0.33/min (25%), p = 0.001), showing a large effect size (d = 1.11). The workflow did not significantly differ between the groups (p = 0.079), although a medium effect size was shown (d = 0.563) with the tendency of the CON group deviating stronger from the ABCDE than the INT.
CONCLUSIONS: Checklists can have positive effects on outcome in the prehospital setting by significantly facilitates adherence to guidelines. Checklist use may be time-effective in the prehospital setting.
Checklists based on the \'ABCDE\' mnemonic can be used according to the \'do verify\' approach. Team Time Outs are recommended to start and finish
checklists.