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Development and Usability Testing of the Society for Pediatric Anesthesia Pedi Crisis Mobile Application

Clebone, Anna MD*; Strupp, Kim M. MD; Whitney, Gina MD; Anderson, Michael R. BS; Hottle, Jeffrey BA§; Fehr, James MD‖,¶; Yaster, Myron MD; Schleelein, Laura E. MD#; Burian, Barbara K. PhD**; Galvez, Jorge A. MD, MBI; Lockman, Justin L. MD; Polaner, David MD, FAAP; Barnett, Natalie R. MD; Keane, Michael J. MD; Manikappa, Shashikanth MD; Gleich, Stephen MD; Greenberg, Robert S. MD; Vincent, Ariel; Oswald, Sarah L. MD; Starks, Red MD; Licata, Scott MD; the Pedi Crisis Application Working Group

doi: 10.1213/ANE.0000000000003935
Pediatric Anesthesiology

When life-threatening, critical events occur in the operating room, the fast-paced, high-distraction atmosphere often leaves little time to think or deliberate about management options. Success depends on applying a team approach to quickly implement well-rehearsed, systematic, evidence-based assessment and treatment protocols. Mobile devices offer resources for readily accessible, easily updatable information that can be invaluable during perioperative critical events. We developed a mobile device version of the Society for Pediatric Anesthesia 26 Pediatric Crisis paper checklists—the Pedi Crisis 2.0 application—as a resource to support clinician responses to pediatric perioperative life-threatening critical events. Human factors expertise and principles were applied to maximize usability, such as by clustering information into themes that clinicians utilize when accessing cognitive aids during critical events. The electronic environment allowed us to feature optional diagnostic support, optimized navigation, weight-based dosing, critical institution-specific phone numbers pertinent to emergency response, and accessibility for those who want larger font sizes. The design and functionality of the application were optimized for clinician use in real time during actual critical events, and it can also be used for self-study or review. Beta usability testing of the application was conducted with a convenience sample of clinicians at 9 institutions in 2 countries and showed that participants were able to find information quickly and as expected. In addition, clinicians rated the application as slightly above “excellent” overall on an established measure, the Systems Usability Scale, which is a 10-item, widely used and validated Likert scale created to assess usability for a variety of situations. The application can be downloaded, at no cost, for iOS devices from the Apple App Store and for Android devices from the Google Play Store. The processes and principles used in its development are readily applicable to the development of future mobile and electronic applications for the field of anesthesiology.

From the *Department of Anesthesiology and Critical Care Medicine, University of Chicago, Chicago, Illinois

Department of Anesthesiology, Children’s Hospital Colorado, University of Colorado, Aurora, Colorado

Anderson Applications Limited, Denver, Colorado

§Hottle Interactive LLC, Denver, Colorado

Departments of Anesthesiology

Pediatrics, Washington University School of Medicine, St Louis Children’s Hospital, St Louis, Missouri

#Departments of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

**United States National Aeronautics and Space Administration, Ames Research Center, Moffett Field, California.

Published ahead of print 11 December 2018.

Accepted for publication October 8, 2018.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Anna Clebone, MD, Department of Anesthesiology and Critical Care Medicine, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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