Understanding the Cognition and Decision Making of Community Anesthesiologists in Their Management of End-of-case Neuromuscular Blockade: A Mixed Methods Study
概览
- 阶段
- 不适用
- 干预措施
- Anesthesia Providers
- 疾病 / 适应症
- Neuromuscular Blockade
- 发起方
- Vanderbilt University Medical Center
- 入组人数
- 154
- 试验地点
- 1
- 主要终点
- Accuracy on 9-item NMMR Knowledge Test
- 状态
- 已完成
- 最后更新
- 2个月前
概览
简要总结
The investigators are interested in studying why experienced clinicians make specific decisions regarding the monitoring of patients' physiological states and why clinicians might make decisions that are contrary to current best practices or known evidence. More generally, the program objective is to refine and validate a novel methodology to delineate clinicians' decision-making strategies. More specifically, the investigators will study the decision to reverse neuromuscular blockade at the end of an anesthetic. This clinical decision will be studied in this project because: 1) it has been well documented that a substantial percentage of practitioners do not follow best practices; 2) the variables are relatively circumscribed and well described; and 3) it can be framed as a binary decision.
The investigators propose to conduct an observational mixed-methods study developing and using clinical vignettes and cognitive interviews to better understand the decision-making approaches and preferences of clinically active anesthesia providers with regard to their decision-making during clinical anesthesia cases. After developing clinical vignettes and related questions, the investigators will first obtain detailed demographic and clinical practice variables from the participants via a survey. Participants will then review multiple vignettes that present different clinical situations that focus on decisions to reverse neuromuscular blockade and/or extubate the patient. Each participant will provide their decisions for each vignette. The investigators will then conduct an audiotaped interview, using cognitive task analysis methods, to ascertain the factors that played a role in these decisions.
详细描述
The investigators propose to conduct a 3-site prospective observational mixed-methods study using clinical vignettes and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of non-depolarizing neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases. The objectives of this initial study is to begin to understand: 1. When and why do community anesthesiologists choose to reverse NMB? 2. What are the decision preferences of community anesthesiologists with regard to their decisions to reverse NMB, and what are the clinician and clinical case factors that influence those decisions? 3. What are the operational knowledge gaps of anesthesia professionals with regard to their ability to follow best-practice evidence for the reversal of NMB? More generally, the program objective is to refine and validate a novel methodology to delineate clinicians' decision making strategies and triggers. 2.1.2. Study Hypotheses For this initial study, the investigators hypothesize that: 1. There will be a significant distribution of clinical variables across community anesthesiologists' decision to reverse NMB. 2. There will be measurable differences in participant demographics and practice attributes between those who closely follow evidence-based expectations for reversal of NMB and those who do not. The investigators expect community practitioners who do not reverse NMB in accordance with current best evidence to be older, to not be fellowship trained or subspecialty certified, and to practice in lower acuity settings. This will be a remotely conducted national prospective observational simulation study of 36 experienced community anesthesiologists using a clinical vignette and cognitive interviews to better understand the decision making approaches and preferences of practicing community anesthesiologists with regard to the management of neuromuscular blockade (NMB) at the end of general endotracheal anesthesia cases. Cognitive interview transcript coders and analysts will be blinded to the identity and attributes of the participants.
研究者
Matthew Weinger
Professor
Vanderbilt University Medical Center
入排标准
入选标准
- •Clinically active experienced anesthesia providers
排除标准
- •Anesthesia providers who are no longer practicing or clinically active
研究组 & 干预措施
Anesthesia Providers
Clinically active anesthesia providers
结局指标
主要结局
Accuracy on 9-item NMMR Knowledge Test
时间窗: Day of enrollment only
Percent correct on 9-item test of evidence-based knowledge about neuromuscular monitoring and reversal
Confidence in NMMR Knowledge
时间窗: Day of enrollment
% confidence (0-100) in the correctness of participant's response on the knowledge test