Letters to the Editor: Letter to the Editor
It is gratifying to read Ranganathan et al.’s1 description of a successful team effort in managing a malignant hyperthermia emergency, attributed in part to the use of a cognitive aid. The authors have quite rightly identified that improved coordination and reduced reliance on memory are important in enhancing the team’s performance with an aid.
However, it is currently unclear from the literature to what extent existing cognitive aids support or hinder effective team behavior.2 Factors such as the personnel available, time pressures, and noise during an anesthetic emergency must be taken into account in the design and implementation of new cognitive aids. Other key issues for consideration include how the aid is presented, the team’s familiarity with the aid, the team’s structure, and the ability to disseminate the information within the team.3
In the case described by Ranganathan et al.,1 it appears that the team used a “reader” of the cognitive aid. This strategy has been suggested to enhance team performance by developing shared situation awareness and improved team communication.4
Clearly, it would be difficult and undesirable to test the designs and methods of use of cognitive aids on actual patients because of the risk of harm and the thankfully infrequent nature of these events. Immersive simulation studies using whole teams in actual or replicated clinical settings provide a potential solution and allow experimental control to test the appropriateness of design and method of use of cognitive aids. Nevertheless, reports of successful use are valuable sources of feedback and link these simulation studies to clinical practice.
Stuart D. Marshall, MB.ChB. M. HumanFact
Academic Board of Anesthesia and Perioperative Medicine
Cognitive Engineering Research Group
School of Psychology
The University of Queensland
Monash Medical Centre
1. Ranganathan P, Phillips JH, Attaallah AF, Vallejo MC. The use of cognitive aid checklist leading to successful treatment of malignant hyperthermia in an infant undergoing cranioplasty. Anesth Analg. 2014;118:1389
2. Marshall S. The use of cognitive aids during emergencies in anesthesia: a review of the literature. Anesth Analg. 2013;117:1162–71
3. Degani A, Wiener EL. Cockpit checklists: Concepts, design and use. Hum Factors. 1993;35:345–59
4. Burden AR, Carr ZJ, Staman GW, Littman JJ, Torjman MC. Does every code need a “reader?” improvement of rare event management with a cognitive aid “reader” during a simulated emergency: a pilot study. Simul Healthc. 2012;7:1–9