Obstetrical Emergency Situations Clinical Trial
Official title:
Cognitive Aids With Roles Defined (CARD) for Obstetrical Crises: A Multisite Cohort Study
Crisis resource management represents the set of non technical skills, such as communication,
leadership, delegation, and prioritization, that allow effective teamwork for optimal patient
care during an urgent and critical situation. The Cognitive Aids with Roles Defined (CARD) is
a new concept of cognitive aid addressing the well-documented issue of teamwork in crisis
management. It relies on large identification cards specially designed for each team members
profession and role. During a life threatening clinical situation, the CARD protocol focuses
on clarification of individual roles and distribution of tasks for crisis management rather
than creating an additional algorithm identifying either a list of actions to be taken or the
dose of a medication. This study aims to evaluate the clinical impact of introducing the CARD
protocol in obstetrical emergency situations ("code 333") in clinical practice at The Ottawa
Hospital.
Hypothesis: CARD protocol will: (i) decrease the total time taken to deliver the baby, and
(ii) improve clinical outcome for the mother and baby compared to traditional management
without the CARD protocol.
The CARD protocol offers an innovative yet simple solution to the barriers in crisis
management that the literature has already identified. The study is part of a research
program investigating strategies to improve crisis management. After completing several
simulation studies on cognitive aids, crisis management debriefing, and a pilot CARD study,
the investigators aim to explore and investigate the impact of an intervention on patient
care.
The concept of a self-organizing team with explicitly defined roles may enhance patient
safety. The CARD approach to crisis management is relevant to a broad number of situations,
disciplines, and professions. The CARD protocol is easily exportable to any critical
situation including intra-hospital arrest, trauma, or critical care patients. The concept of
a self-organizing team with defined roles may ultimately enhance patient safety.
The investigators anticipate that their proposal will challenge the traditional way of
thinking about cognitive aid, and may advance the theory in the two fields of cognitive aid
and team work for crisis management.
The CARD cards with their associated roles and list of tasks will be specifically designed
for code 333. In the 'baseline' phase, a research assistant will review Birthing Unit records
daily to determine if a code 333 had been called in the preceding 24 hours. Outcome measures
will be collected to establish baseline team performance. In order to account for the 'team
training effect' and identify the 'CARD effect', both groups will receive didactic and
simulation crisis management teaching, but training at the "case site" will include CARD
teaching while the contemporaneous "control site" will receive team training without CARD.
After the training period at both sites, CARD will be implemented at the "case sight" for
code 333s while the "control site" will continue without CARD. Maternal and neonatal outcomes
as well as team performance (times to delivery) will continue to be prospectively collected
throughout.
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