Trial of Emergency Medicine Protocols In Simulation Training
Do cognitive aids reduce error rates in resuscitation team performance? Trial of Emergency Medicine Protocols in Simulation Training (TEMPIST).
TEMPIST is an Australian randomised controlled trial that tests the effectiveness of the Emergency Protocols in a simulated Emergency Department environment by observing team error rates when current resuscitation guidelines were followed, with and without the handbook.
The TEMPIST investigators are:
- A/Prof Charlotte Hall (Medical Educator and Human Factors Specialist, Northern NSW)
- Dr Dean Robertson (GP VMO, Emergency Department, Maclean District Hospital)
- A/Prof Megan Passey (Deputy Director of Research, University Centre for Rural Health, Lismore and Director, Australian Rural Health Research Collaboration, University of Sydney)
- Dr Sabrina Pitt (Workforce Research Stream Leader, University Centre for Rural Health, Lismore and School of Public Health, University of Sydney)
- Dr Margaret Rolfe (Biostatistician and Research Fellow, University Centre for Rural Health, Lismore and School of Public Health, University of Sydney)
- Ms Sharene Pascoe (Clinical Simulation Manager, University Centre for Rural Health, Lismore and Clinical Nurse Consultant, Lismore Base Hospital)
Resuscitation teams were randomised to manage two scenarios with the Emergency Protocols and two without in a high-fidelity simulation centre. Each scenario was video-recorded. The primary outcome measure was error rates (the number of errors made out of 15 key tasks per scenario). Key tasks varied by scenario. Each team completed four scenarios and was measured on 60 key tasks. Participants were surveyed regarding their perception of the usefulness of the Emergency Protocols handbook.
The error rate decreased by 54% when the Emergency Protocols were used.
Twenty-one groups performed 84 Emergency Department crisis simulations. The unadjusted error rate in the handbook group was 18.8% (121/645) versus 38.9% (239/615) in the non-handbook group. There was a statistically significant reduction of 54.0% (95% CI 49.9–57.9) in the estimated percentage error rate when the handbook was available across all scenarios 17.9% (95% CI 14.4–22.0%) versus 38.9% (95% CI 34.2–43.9%).
Almost all (97%) participants said they would want to use the Emergency Protocols handbook during a real medical crisis situation.
TEMPIST showed that by following the step-by-step, linear pathways in the handbook, clinicians more than halved their teams’ rate of error, across four simulated medical crises.
The handbook improves team performance and enables healthcare teams to reduce clinical error rates and thus reduce harm for patients.
The demonstration of significant benefit to the patient from the use of a cognitive aid, combined with evidence from other industries, suggests that the next step is to implement cognitive aids in practice. Optimal resuscitation care is achieved through standardisation. Standardised practice results in less unwanted variation, thereby reducing errors and improving outcomes. However, the challenge is to promulgate standardised processes.
TEMPIST was published by BioMed Central with open access:
Hall C, Robertson D, Rolfe M, Pascoe S, Passey ME, Pitt SW. Do cognitive aids reduce error rates in resuscitation team performance? Trial of Emergency Medicine Protocols In Simulation Training (TEMPIST) in Australia. Human Resources for Health. 2020; 18:1.
The full TEMPIST trial is available for free download below.