Using Emergency Manuals During Interprofessional Crisis Management: Are There Unintended Consequences?

Despite increasing interest in emergency manuals (EMs), relatively little is known about
their effectiveness and limitations in the perioperative setting. Prior studies have been
limited in that they evaluated EMs using crises that were tailor-made to match one of their
chapters, and there has been minimal participation by attending surgeons and other
experienced personnel. The Investigators' preliminary experience suggests less-than-expected
EM use and suboptimal usage, which may be due to the simulation scenario falling "halfway
between" two different chapters of the EM, raising the question of whether limitations were
due to the EM content, team dynamics, or inadequate training in the EM use. In this
randomized, prospective, two-center simulation-based study, the investigators utilize
clinical scenarios specifically designed to observe the patterns of use and to test the
limitations of the EMs. The hypothesis is that EMs may not improve, and may even worsen,
clinical performance in situations that do not exactly match a specific chapter of that EM,
and that EM usage patterns will identify both strengths and limitations of the tools and its
implementation. The participating healthcare providers consisting of experienced surgeons,
anesthesiologists, and nurses will be randomized into four experimental groups, each exposed
to either a "specific" or "non-specific" simulation scenario, along with or without the
availability of the EM. The major experimental endpoint will be how many "critical actions"
each team performs, scored as the percentage of actions taken from a pre-determined list.
The goal of this study is to improve EM content and use by understanding its limitations
during interprofessional team-training simulations and to study whether EMs enhance or
detract from clinical performance. This is especially a concern in situations that do not
exactly match a specific chapter of the EM, such as cases that are vague and represent
multi-factorial diagnostic dilemmas such as hypotension and hypoxemia. The ultimate goal is
to strengthen patient safety by providing guidance for improving EM content, use, and
training protocols.