The Effect of an Electronic Dynamic Cognitive Aid Versus a Static Cognitive Aid on the Management of a Simulated Crisis: A Randomized Controlled Trial

  • Torin D. ShearEmail author
  • Mark Deshur
  • Jessica Benson
  • Steven Houg
  • Chi Wang
  • Jeffrey Katz
  • Pam Aitchison
  • Peggy Ochoa
  • Ernest Wang
  • Joseph Szokol
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


The aim of this study was to assess the effect of a dynamic electronic cognitive aid with embedded clinical decision support (dCA) versus a static cognitive aid (sCA) tool. Anesthesia residents in clinical anesthesia years 2 and 3 were recruited to participate. Each subject was randomized to one of two groups and performed an identical simulated clinical scenario. The primary outcome was task checklist performance with a secondary outcome of performance using the Anesthesia Non-technical skills (ANTS) scoring system. 34 residents were recruited to participate in the study. 19 residents were randomized to the sCA group and 15 to the dCA group. Overall inter-rater agreement for total checklist, malignant hyperthermia, hyperkalemia and ventricular fibrillation was 98.9%, 97.8%, 99.5% and 99.5% respectively with similar Kappa coefficient. Inter-rater agreement for ANTS partial ratings, however, was only 53.5% with a similar Kappa of 0.15. Mean performance was statistically higher in the dCA group versus the sCA group for total check list performance (15.70 ± 1.93 vs 12.95 ± 2.16, p < 0.0001). The difference in performance between dCA and sCA is most notable in dose-dependent related checklist items (4.60 ± 1.3 vs 1.89 ± 1.23, p < 0.0001), while the performance score for dose-independent checklist items was similar between the two groups (p = 0.8908). ANTS ratings did not differ between groups. In conclusion, we evaluated the use of a sCA versus a dCA with embedded decision support in a simulated environment. The dCA group was found to perform more checklist items correctly.

Clinical Trial Registration: study #: NCT02440607.


Simulation Cognitive aid Crisis management 



Special thanks to the staff of the Grainger Center for Simulation and Innovation. NorthShore University HealthSystem.

Compliance with Ethical Standards

Summary Statement


Sources of Financial Support

Support was provided from institutional and/or departmental sources and a grant from the Women’s Auxillary Board, NorthShore University HealthSystem.

Conflict of Interest

The authors declare no competing interests.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyNorthShore University HealthSystem, University of Chicago Pritzker School of MedicineEvanstonUSA
  2. 2.Grainger Center for Simulation and InnovationNorthShore University HealthSystemEvanstonUSA
  3. 3.Center for Biostatistics and Research InformaticsNorthShore University HealthSystem Research InstituteEvanstonUSA
  4. 4.Division of Emergency MedicineNorthShore University HealthSystem, University of Chicago Pritzker School of MedicineEvanstonUSA

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