Improving Prehospital Providers’ Confidence in Performing Cricothyrotomies via Simulation and Cognitive Aid

Abstract

Purpose: The primary purpose of this quality improvement project was to improve prehospitalproviders’ confidence in performing an emergency surgical cricothyrotomy after implementing a cognitive aid and hands-on training with a high-fidelity cricothyrotomy simulator. Additional goals of this project included enhancing prehospital providers' self-assessed competence, knowledge, and procedural skills. Background: Failure in airway management continues to be a leading cause of preventable patient harm (Joffe et al., 2019). Simulating emergency airway skills can improve performance, speed, and confidence in providers, and the use of cognitive aids in emergencies is shown to improve the speed, performance, and accuracy of providers (Añez Simón et al., 2019; Marshall & Mehra, 2014). Despite the evidence of utilizing these tools, many prehospital providers in Southern Arizona do not have access to and are not utilizing high-fidelity airway simulation. Additionally, no standard cognitive aid is currently being utilized in this region. Methods: This education-based quality improvement (QI) project utilized a pre-post design. Participants were assessed using an adapted confidence scale (C-scale), a perceived competence survey, a knowledge-based quiz, and a cricothyrotomy skills assessment tool while performing a surgical cricothyrotomy on an inexpensive high-fidelity simulator. Results: Significant improvements were observed post-intervention compared to pre- intervention in provider confidence (p < 0.01; d= 2.03) and perceived competence scores (p<0.01; d= 1.96). Participants demonstrated statistically significant improvements in skill performance and enhanced adherence to critical steps based on skills assessment scores (p < 0.01; d= 0.97). There were also statistically significant improvements in procedural efficiency 13 (p<0.01; d= 0.81), as evidenced by the average time to procedural completion being 54 seconds faster post- versus pre-intervention. Knowledge scores showed a slight, non-significant improvement (p >0.05; p = 0.083). Conclusion: This project supports the efficacy of a cognitive aid and high-fidelity simulation to improve provider confidence, competence, and skill in performing emergency surgical cricothyrotomy. With these findings, it can be concluded that the use of a cognitive aid with high-fidelity procedural simulators is effective at increasing provider confidence, competence, and skill in successfully performing a surgical cricothyrotomy.