PT - JOURNAL ARTICLE AU - Eric Dryver AU - Jakob Lundager Forberg AU - Caroline Hård af Segerstad AU - William D Dupont AU - Anders Bergenfelz AU - Ulf Ekelund TI - Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial AID - 10.1136/bmjqs-2020-012740 DP - 2021 Sep 01 TA - BMJ Quality & Safety PG - 697--705 VI - 30 IP - 9 4099 - http://qualitysafety.bmj.com/content/30/9/697.short 4100 - http://qualitysafety.bmj.com/content/30/9/697.full SO - BMJ Qual Saf2021 Sep 01; 30 AB - Background Studies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown.Methods Eight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs—of which two belong to an academic centre—and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed.Results A total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10−8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1–6, most participants agreed (gave a score of 5 or 6) with the statement ‘I would use the checklist if I got a similar case in reality’.Conclusion In this multi-institution study, checklists markedly improved local resuscitation teams’ management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. The data collected for this study and the programs that analysed these data are publicly available. The data for this study are posted at https://www.dropbox.com/sh/u1xfkz2s7fyjxsc/AAD3l3ZL1mHqoeRkNDkTCKr0a?dl=0inanExcelspreadsheetnamedChecklists_ED_interventions.xlsx. It is freely available to anyone. To make a copy of this file, go to this URL, pull down the Open box next to Checklists_ED_interventions.xlsx and select 'Open in Excel'.