SPE03 Ellison C. Pierce, Jr., M.D. Patient Safety Memorial Lecture: Competence and Teamwork Are Not Enough: The Value of Cognitive Aids
Saturday, October 11, 2014, 1 - 2 p.m.
David Gaba, M.D.
Successful care of the patient used to be considered solely as due to the individual knowledge and skill embodied in the single anesthesiologist. We now recognize the importance of teamwork – and team management – by the anesthesiologist. Yet for all other human activities of high intrinsic danger (e.g., aviation, nuclear power production), it is know that these factors alone are not enough to optimize safety and productivity, in part because human memory is limited and fallible, especially under stress. A principle of human factors is to use both knowledge in the head (memory) and knowledge in the world (presented externally) for optimal results. Cognitive aids are various physical and electronic representations of knowledge in the world designed to assist anesthesiologists and their co-workers in executing complex decision-making in dynamic settings, such as managing the anesthetized patient. Examples of such aids include pre-work checklists (e.g., anesthesia machine check, WHO pre-surgical checklist); emergency manuals (to be used in real-time to guide problem-solving); tables, nomograms and calculators; and electronic systems (anesthesia information systems and decision-support software). This lecture will review the rationale for and the different types of cognitive aids that have been developed for perioperative settings, with an emphasis on emergency manuals. It will also discuss how their use can be integrated with individual competence and knowledge and inter-professional teamwork to achieve optimal patient safety. The status of adoption of cognitive aids and their likely future evolution will also be explored.
David Gaba, M.D. is associate dean for Immersive and Simulation-Based Learning, and professor of Anesthesia, Stanford University School of Medicine and co-director, Patient Simulation Center of Innvoation, and staff physician, VA Palo Alto Health Care System, Palo Alto, California. He is also editor-in-chief of Simulation in Healthcare.