Impediments to and impact of checklists on performance of emergency interventions in primary care: an in situ simulation-based randomized controlled trial

Abstract

Objective

Medical crises occur rather seldom in the primary care setting, but when they do, initial management impacts on morbidity and mortality. Factors that impede the performance of emergency interventions in primary care have not been studied through in-situ simulation. Checklists reportedly improve crisis management.

Design

This randomized controlled trial evaluated emergency intervention performance during two scenarios (hypoglycemia-coma and anaphylaxis-cardiac arrest) simulated at primary care centers, and whether checklist access improved performance.

Setting

Twenty-two primary care centers in Southern Sweden participated in the study.

Subjects

A total of 347 personnel performed 100 simulations, 45 with and 55 without checklist access.

Main outcome measures

Time and impediments to performance of five emergency interventions in each scenario.

Results

On 28 of the 37 occasions when the adrenalin auto-injector was employed, the administration technique was incorrect. In 9 of 49 scenarios, teams had trouble locating the 30% glucose solution. Median time to supplemental oxygen administration during the first scenario was 186 s compared with 96 s during the second scenario (p < 0.001). Checklist access had no significant impact on time to performance of emergency interventions, aside from shorter time to adequate glucose or glucagon administration (median times 632 s with, 756 s without checklist access; p = 0.03).

Conclusion

Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting. Simply providing checklist access does not improve the performance of emergency interventions.

KEY POINTS

• Little is known about the factors that affect the performance of emergency interventions in the primary care setting.

• Unfamiliarity with local emergency equipment impedes the performance of emergency interventions during crises simulated in the primary care setting.

• Simply providing crisis checklist access does not improve the performance of emergency interventions in the primary care setting.

Keywords:

• Checklist
• emergencies
• patient safety
• simulation training
• primary health care

Acknowledgements

The authors thank all primary care centers that took part in the study: Vårdcentralen Rosengård, Malmö; Vårdcentralen Lomma; Vårdcentralen Kärråkra, Eslöv; Vårdcentralen Påarp-Mörarp; Vårdcentralen Centrum, Landskrona; Vårdcentralen Bokskogen; Vårdcentralen Staffanstorp; Vårdcentralen Löddeköpinge; Läkarhuset Roslunda, Ängelholm; Vårdcentralen Tåbelund, Eslöv; Vårdcentralen Linero Östra Torn, Lund; Vårdcentralen Sjöcrona, Höganäs; Helsa Vårdcentral, Bromölla; Vårdcentralen Dalby; Vårdcentralen Gullviksborg, Malmö; Vårdcentralen Lunden, Malmö; Vårdcentralen Sjöcrona, Höganäs; Vårdcentralen Råå, Helsingborg; Läkargruppen Munka-Ljungby; Helsa Vårdcentral, Lönsboda; Vårdcentralen Osby; Brahehälsan, Eslöv; Vårdcentralen Södertull, Lund.

Ethical approval

The Regional Ethics Review Board of Lund approved the study (Dnr 2013/289).

Disclosure statement

The authors have no conflicts of interest.

Additional information

Funding

REGSKANE-814271 and REGSKANE-627931.