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Adherence to Guidelines for the Management of Local Anesthetic Systemic Toxicity Is Improved by an Electronic Decision Support Tool and Designated “Reader”
  1. Matthew D. McEvoy, MD*,
  2. William R. Hand, MD,
  3. W. David Stoll, MD,
  4. Cory M. Furse, MD, MPH and
  5. Paul J. Nietert, PhD
  1. *Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN
  2. Departments of Anesthesia and Perioperative Medicine, Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC
  3. Department of Medicine, Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC
  1. Address correspondence to: Matthew D. McEvoy, MD, Department of Anesthesiology, Vanderbilt University School of Medicine, 2301 Vanderbilt University Hospital, Nashville, TN 37232-7237 (e-mail: matthew.d.mcevoy{at}


Background and Objectives A hardcopy or paper cognitive aid has been shown to improve performance during the management of simulated local anesthetic systemic toxicity (LAST) when given to the team leader. However, there remains room for improvement to ensure a system that can achieve perfect adherence to the published guidelines for LAST management. Recent research has shown that implementing a checklist via a designated reader may be of benefit. Accordingly, we sought to investigate the effect of an electronic decision support tool (DST) and designated “Reader” role on team performance during an in situ simulation of LAST.

Methods Participants were randomized to Reader + DST (n = 16, rDST) and Control (n = 15, memory alone). The rDST group received the assistance of a dedicated Reader on the response team who was equipped with an electronic DST. The primary outcome measure was adherence to guidelines.

Results For overall and critical percent correct scores, the rDST group scored higher than Control (99.3% vs 72.2%, P < 0.0001; 99.5% vs 70%, P < 0.0001, respectively). In the LAST scenario, 0 (0%) of 15 in the control group performed 100% of critical management steps, whereas 15 (93.8%) of 16 in the rDST group did so (P < 0.0001).

Conclusions In a prospective, randomized single-blinded study, a designated Reader with an electronic DST improved adherence to guidelines in the management of an in situ simulation of LAST. Such tools are promising in the future of medicine, but further research is needed to ensure the best methods for implementing them in the clinical arena.

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  • The authors declare no conflict of interest.

    Supported by the Foundation for Anesthesia Education and Research (FAER), Research in Education Grant (PI: McEvoy). This project was also supported by the South Carolina Clinical and Translational Research Institute, Medical University of South Carolina’s CTSA, NIH/NCATS Grant Number UL1TR000062.

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