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Implementing Emergency Manuals: Can Cognitive Aids Help Translate Best Practices for Patient Care During Acute Events?

Goldhaber-Fiebert, Sara N. MD*; Howard, Steven K. MD†*

doi: 10.1213/ANE.0b013e318298867a
Patient Safety: Special Article

In this article, we address whether emergency manuals are an effective means of helping anesthesiologists and perioperative teams apply known best practices for critical events. We review the relevant history of such cognitive aids in health care, as well as examples from other high stakes industries, and describe why emergency manuals have a role in improving patient care during certain events. We propose 4 vital elements: create, familiarize, use, and integrate, necessary for the widespread, successful development, and implementation of medical emergency manuals, using the specific example of the perioperative setting. The details of each element are presented, drawing from the medical literature as well as from our combined experience of more than 30 years of observing teams of anesthesiologists managing simulated and real critical events. We emphasize the importance of training clinicians in the use of emergency manuals for education on content, format, and location. Finally, we discuss cultural readiness for change, present a system example of successful integration, and highlight the importance of further research on the implementation of emergency manuals.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, and VA Palo Alto Health Care System, Palo Alto, California.

Accepted for publication April 17, 2013.

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Sara N. Goldhaber-Fiebert, MD, Department of Anesthesia, Stanford University School of Medicine, 300 Pasteur Drive Room H3580, Stanford, CA 94305-5640. Address email to

© 2013 International Anesthesia Research Society