[Treatment quality with and without an electronic cognitive aid for emergencies in anaesthesia (eGENA) : The DANGER pilot study part 2 in randomized controlled in-situ emergency simulations]

Background: The electronic cognitive aid for emergencies in anesthesia (eGENA) is an app that offers digital support in anesthesiological emergency situations as a cognitive aid tool via checklists for memory and making decisions. The eGENA was published by the German Society of Anesthesiology and has been implemented in the emergency management of the anesthesiological team of the clinic in Potsdam, Germany.

Objective: The primary endpoint was to observe the influence of eGENA on the anesthesiological emergency management on the subjective feeling of assurance as well as on quality of treatment and, therefore, patient safety.

Material and methods: All employees in the anesthesia department (nursing staff and physicians) took part in the initial implementation of eGENA. The implementation phase covered crew resource management (CRM) principles and eGENA use as well as 10 case studies that were discussed with help from eGENA. Afterwards in a randomized controlled simulation study, realistic case studies were processed and evaluated. In this, 18 cases were handled by 9 groups with 4 persons in each group. Treatment during these simulations was assessed using a predetermined 20-point evaluation form and 10 resuscitation-related and 10 case-related points were awarded. Significance tests were carried out using the Wilcoxon-test (significance level p < 0.05) and two evaluations were completed by the attendees at the beginning and the end of the eGENA implementation process.

Results: Scenarios 1 and 2 showed comparable overall scores (14.9 vs. 16.3 points out of 20, not significant). Higher case-associated scores (7.6 vs. 5.6 out of 10, p = 0.03) and higher total scores were achieved with the help of eGENA (16.9 vs. 14.3 out of 20, p = 0.02). Resuscitation-associated scores did not differ significantly (9.3 vs. 8.8 of 10, p = 0.1). During eGENA use for cases the execution of the algorithm-based resuscitation measures was not delayed or accelerated. With eGENA, however, differential diagnoses were discussed significantly more frequently and expanded treatment and diagnostic measures were implemented. During simulation cases eGENA was mainly used by physicians. The initially very positive responses of the evaluations toned down over time. Planned eGENA use for self-study was less frequent (p = 0.006) and there was less approval of the quality of treatment by eGENA than in the first survey (p = 0.002). The cooperation between doctors and nurses in emergency treatment showed an improvement (p < 0.001). The questions about self-assessed safety in emergency treatment on a scale from 0 to 10 showed higher values in all categories at the second survey (except only circulatory emergencies and 'other' emergencies). The respondents were more likely to be involved in emergency treatment at the second time of the survey (p = 0.03) after a median of 20 months.

Discussion: The sense of security and emergency involvement increased significantly over the observation period. The initial need to use eGENA in everyday life has diminished over time; however, these results cannot be causally associated with eGENA. The use of eGENA does not improve resuscitation efforts but does not delay them either. With the use of eGENA better case-associated results are achieved and advanced diagnostics and treatment are implemented more frequently in complex emergency situations. This increases the quality of treatment. Further studies should be carried out with a larger number of cases to confirm the shown effects.