One of the most challenging aspects of cognitive aids in crisis management is their implementation. For many well-documented reasons, there has been a reluctance (particularly in the older clinician population) to embrace the concept of cognitive aids.
Improving engagement with clinicians is the key to successful adoption of the crisis manual. We feel we have taken care of the content and aesthetics. The manual’s contents are written in accordance with evidence-based guidelines if they exist, and if not, are supported by references (see website reference page) or professional consensus.
The striking but carefully considered design and the use of primary colours contributes to its visual appeal, encouraging healthcare professionals to pick up and ‘flick through’. This in itself promotes awareness and familiarity.
Finally, the minimalist approach to layout, documentation and lists, even to the point of each word being scrutinized for accuracy and simplicity, provides an intuitive and easy to follow format.
To promote manual use, we suggest engaging a local advocate or ‘champion’ and to follow these suggestions where possible:
Place in every anaesthetising location in a highly visible and accessible position – this usually means fixing to the anaesthetic machine or trolley (cart).
Declaring the manual and its location as a key component of the Surgical Safety Checklist.
As part of the Call (for help), Communicate (the problem), Delegate (task or responsibilities) mantra of crisis management, delegating the role of ‘reader’ early provides the team leader with some support if needed. We prefer to use the manual as a reference or support tool rather than to direct the person leading the resuscitation. We also accept however, there is a school of thought supporting the use of manuals as tools of instruction that should be followed step by step. The loss of ‘flow’ when managing unfolding events using such a method, makes us wary of this technique. In reality, there is probably an ideal combination of the two.
The use of simulation training plays an important role in aviation and has now become a core component of anaesthesiology training programs around the western world. It is also increasingly important in continuous medical education (CME). The introduction and explanation of The ACM during simulation training provides a solid foundation for ongoing clinician engagement.
The ACM is ideally suited for Teaching On The Run programs popular in healthcare. It provides concise, well-presented and important material for all anaesthesiologists and trainees, readily accessible for self testing and discussion.
If the opportunity arises, sponsorship by Associations or Training Colleges is highly recommended. The Australian Society of Anaesthetists has become a strong advocate of The ACM and provides a free copy to all advanced trainees in Australia. The trainee then becomes familiar with its contents and the use of crisis manuals becomes part of their anaesthetic culture.
In the future we envisage further integration of protocols into anaesthetic monitoring, but until then the quickest, most easily accessible and user friendly method of following guidelines remains the humble hardcopy.
Carrying a personal copy as well as keeping hardcopies in all operating environments, contributes to an awareness and familiarity that in turn, should lead to improved patient safety.