Paper or plastic? Simulation based evaluation of two versions of a cognitive aid for managing pediatric peri-operative critical events by anesthesia trainees: evaluation of the society for pediatric anesthesia emergency checklist

Cognitive aids (CA), including emergency manuals and checklists, are tools designed to assist users in prioritizing and performing complex tasks during time sensitive, high stress situations (Marshall in Anesth Analgesia 117(5):1162–1171, 2013; Marshall and Mehra in Anaesthesia 69(7):669–677, 2014). The society for pediatric anesthesia (SPA) has developed a series of emergency checklists tailored for use by pediatric perioperative teams that cover a wide range of intraoperative critical events (Shaffner et al. in Anesth Analgesia 117(4):960–979, 2013). In this study, we evaluated user preferences for a CA (SPA checklist) using two different presentation formats, paper and electronic, during management of simulated critical events. Anesthesia trainees managed the simulated critical events under one of three randomized conditions: (1) memory alone, (2) with a paper version of the CA, (3) with an electronic version of the CA. Following participation in the simulated critical events, participants were asked to complete a survey regarding their experience using the different versions of the CA. The percentage of favorable responses for each format of the CA was compared using a mixed effects proportional odds model. There were 143 simulated events managed by 89 anesthesia trainees. Approximately one out of three trainees (electronic 29 %, paper 30 %) assigned to use the CA chose not to use it and completed the scenario from memory alone. The survey was completed by 68 % of participants, 58 % of trainees preferred the paper version and 35 % preferred the electronic version. All survey responses that reached statistical significance favored the paper version. In this study, anesthesia trainees had a favorable opinion of the content and perceived clinical relevance of both versions of the CA. In both quantitative and qualitative analysis, the paper version of the CA was preferred over the electronic version by participants. Despite overall favorable responses to the CA, a sizeable number of participants chose not to use either version the CA during the crisis.