A Checklist Manifesto: Effectiveness of Checklist Use in Hands-On Simulation Examining Competency in Contrast Reaction Management in a Randomized Controlled Study

作者：Parsian Sana; O'Malley Ryan B; Hippe Daniel S; Bush William H; Bhargava Puneet; Chen Linda E; Wang Carolyn L^*

来源：American Journal of Roentgenology, 2018, 211(1): W1-W12.

DOI：10.2214/AJR.17.19384

• checklist
• contrast media
• contrast reaction management
• high-fidelity simulation

OBJECTIVE. The purpose of this article is to assess the performance of a contrast reaction management checklist for optimal management of a contrast reaction scenario created using a high-fidelity hands-on simulation.
MATERIALS AND METHODS. A safety checklist was designed that presented the five adverse events that most commonly occur after administration of IV contrast medium as well as their step-by-step management. Forty-three radiology residents were randomized into two groups, a checklist group (n = 22) and a control group (n = 21), as stratified by postgraduate year. Participants took written tests involving multiple-choice questions 2 months before and immediately after participating in the high-fidelity simulation scenario, which was videotaped and independently evaluated by three graders.
RESULTS. Both groups had similar scores on the multiple-choice question tests taken before and after participation in the simulation (p = 0.35 and p = 0.62, respectively). In the simulation, the checklist group scored significantly higher than the control group with regard to their overall management of a severe contrast reaction (85.1% vs 64.8%; p = 0.001), including individual scores for first-line treatment of bronchospasm (97.0% vs 91.3%; p = 0.035) and use of the correct route of administration and dose of epinephrine (77.3% vs 45.2%; p = 0.021).
CONCLUSION. A standardized contrast reaction management checklist can reduce the number of treatment errors that occur during a simulated severe contrast reaction, particularly with regard to proper administration of epinephrine and treatment of bronchospasm. Such a checklist could be used by radiologists, technologists, and nurses to improve patient safety as a result of improved contrast reaction management and teamwork skills.

• 出版日期2018-7