First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study

Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.

The Impact of Hazard Statement Design Elements in Procedures: Counterintuitive Findings and Implications for Standards

Objective The objective of these studies was to identify hazard statement (HS) design elements in procedures that affected whether both workers and lab participants performed the associated hazard mitigation. Background Many of the incidents in high-risk industries are the result of issues with procedures (e.g., standard operating procedures; SOPs) workers use to support their performance. HSs in these procedures are meant to communicate potential work hazards and methods of mitigating those hazards. However, there is little empirical research regarding whether current hazard design guidelines for consumer products translate to procedures. Method Two experimental studies—(1) a laboratory study and (2) a high-fidelity simulation—manipulated the HS design elements present in procedures participants used while performing tasks. Participants’ adherence to the mitigation of the hazard was compared for the HS designs. Results The guidelines for HSs from consumer products did not translate to procedures. Specifically, the presence of an alert icon, a box around the statement, and highlighting the statement did not improve adherence to HSs. Indeed, the only consistent finding was for the Icon, with its presence reliably predicting nonadherence in both studies. Additionally, the total number of design elements did not have a positive effect on adherence. Conclusion These findings indicate that more fundamental procedure HSs research is needed to identify effective designs as well as to understand the potential attentional mechanisms associated with these findings. Application The findings from these studies indicate that current regulations and guidelines should be revisited regarding hazard presentation in procedures.

User perceptions of different monitor modalities during high-fidelity simulation: Visual-Patient-avatar, Split Screen and Conventional - a qualitative analysis (Preprint)

BACKGROUND Patient safety during anaesthesia is crucially dependent on the monitoring of vital signs. However, the values obtained must also be perceived and correctly classified by the attending care providers. To facilitate these processes, we developed Visual-Patient-avatar- an animated virtual model of the monitored patient, which innovatively presents numerical and waveform data following user-centred design principles. After a high-fidelity simulation study, we analysed participants' perceptions of three different monitor modalities, including this new technique. OBJECTIVE After a high-fidelity simulation study, we analysed participants' perceptions of three different monitor modalities, including this new technique. METHODS This study was a researcher-initiated, single-centre, qualitative study. We asked 92 care providers right after finishing three simulated emergency scenarios about their positive and negative opinions concerning the different monitor modalities. Following qualitative research methods, we processed the field notes obtained and derived main categories and corresponding subthemes. RESULTS We gained a total of 307 statements. Visual-Patient-avatar was the most occurring term in both positive and negative responses. We identified three main categories and divided them into eleven positive and negative subthemes. In assigning the statements to one of the topics, we achieved substantial inter-rater reliability. Most of the statements concerned the design and usability features of the avatar, respectively, the Split Screen mode. CONCLUSIONS This study qualitatively reviewed the clinical applicability of the Visual-Patient-avatar technique in a high-fidelity simulation study and revealed strengths and limitations of the avatar only und Split Screen modality. We received valuable suggestions for improving the design. The requirement of training before clinical implementation was reinforced. The responses regarding the Split Screen suggested that this symbiotic modality generates improved situation awareness combined with numerical data and accurate curves.