An interprofessional cognitive aid to optimise extubation planning for patients with acute spinal cord injury.

BACKGROUND

Early management of patients in the intensive care unit after acute spinal cord injury is challenging, particularly for patients with cervical injury and tetraplegia who have high rates of pneumonia and extubation failure.

OBJECTIVES

The primary objective was to evaluate the usability of a new interprofessional cognitive aid to optimise extubation planning for patients with acute tetraplegia. Secondary objectives were to (i) observe and compare clinician behaviour during high-fidelity simulation scenarios and (ii) compare clinician self-ratings of confidence before and after introduction to the cognitive aid.

METHODS

Dual methods design. Twenty-six intensive care clinicians (doctors, nurses, and physiotherapists) completed two cervical spinal cord-injured patient simulation scenarios in a random order. Between their two scenarios, participants were orientated to the new cognitive aid. Simulations were audiovisually recorded and scored by a blinded observer using a standardised checklist. Pre and post simulation questionnaires and semistructured interviews were completed.

RESULTS

The cognitive aid had good usability across all three disciplines (mean score on the System Usability Scale was 74.4). After introduction to the cognitive aid, clinicians had higher confidence with completing an independent respiratory assessment (p < 0.01) and objective outcome measures required for extubation (p < 0.01) and to discuss their objective findings and ongoing management with the multidisciplinary team (p = 0.04). Significantly more factors related to pneumonia (p < 0.001) and extubation readiness (p < 0.01) were identified, and significantly more time was taken to complete the second simulation (p = 0.03). The simulation scenarios were described as realistic, and the cognitive aid was positively perceived.

CONCLUSIONS

The interprofessional cognitive aid had good usability and enhanced intensive care clinicians' assessment, confidence, and communication about the extubation readiness of patients with acute cervical spinal cord injury.