{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:17:43Z","timestamp":1778285863532,"version":"3.51.4"},"reference-count":17,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,2,13]],"date-time":"2022-02-13T00:00:00Z","timestamp":1644710400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Neuromuscular monitoring should be applied routinely to avoid residual neuromuscular block. However, anaesthetists often refrain from applying it, even when the equipment is available. We aimed to increase neuromuscular monitoring in six Danish anaesthesia departments via e\u2010learning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Interrupted time series study, with baseline data from a previous study and prospective data collection after implementation of the module, which was available for 2\u00a0weeks from 21\u00a0November 2016. We included all patients receiving general anaesthesia with muscle relaxants until 30 April 2017. Main outcome was application of acceleromyography, grouped as succinylcholine only and non\u2010depolarising relaxants. Secondary outcomes were last recorded train\u2010of\u2010four ratio (non\u2010depolarising) relaxants and score on a ten\u2010question pre\u2010 and post\u2010course multiple\u2010choice test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The post\u2010intervention data consisted of 6525 cases (3099 (48%) succinylcholine only, 3426 (52%) non\u2010depolarising relaxants). Analysing all departments, we found a positive pre\u2010intervention trend in application of acceleromyography for both groups, of estimated 7.5% and 4.8% per year, respectively (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001). The monitoring rate increased significantly for succinylcholine in two departments post\u2010intervention (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.045 and .010), and for non\u2010depolarising relaxants in one department (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.041), but followed by a negative trend of \u221237.0% per year (<jats:italic>p\u00a0<\/jats:italic>=\u00a0.041). The rate was already close to 90% at the time of the intervention and the mean last recorded train\u2010of\u2010four ratio was 0.97 (SD 0.21), also without a significant change. The median score on the post\u2010course test increased from 7 (IQR 5\u20138) to 9 (IQR 8\u201310) (<jats:italic>p\u00a0<\/jats:italic>&lt;\u00a0.001, Wilcoxon Signed\u2010Ranks Test).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found no overall effect of the e\u2010learning module on application of neuromuscular monitoring, although the post\u2010course test indicated an effect on anaesthetists\u2019 knowledge in this field.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>Trial registration: Clinicaltrials.gov identifier: NCT02925143. <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02925143\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02925143<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14038","type":"journal-article","created":{"date-parts":[[2022,2,5]],"date-time":"2022-02-05T06:33:43Z","timestamp":1644042823000},"page":"580-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Improving neuromuscular monitoring and reducing residual neuromuscular blockade via e\u2010learning: A multicentre interrupted time\u2010series study (INVERT study)"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2827-7904","authenticated-orcid":false,"given":"Jakob Louis Demant","family":"Thomsen","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ole","family":"Mathiesen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Zealand University Hospital  K\u00f8ge Denmark"},{"name":"Department of Clinical Medicine Copenhagen University  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"H\u00e4gi\u2010Pedersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Copenhagen University  Copenhagen Denmark"},{"name":"Department of Anaesthesiology Slagelse and Ringsted Hospitals  N\u00e6stved Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lene T.","family":"Skovgaard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doris","family":"\u00d8stergaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Copenhagen University  Copenhagen Denmark"},{"name":"Copenhagen Academy for Medical Education and Simulation Herlev Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona R.","family":"G\u00e4tke","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology Herlev and Gentofte Hospital  Herlev Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the INVERT collaborator group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,2,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181da832d"},{"key":"e_1_2_10_3_1","first-page":"3878","article-title":"Does evidence lead to a change in clinical practice? 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