{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:44:40Z","timestamp":1780469080532,"version":"3.54.1"},"reference-count":14,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>During surgery and anesthesia, life-threatening critical events, including cardiac arrest, may occur. By facilitating recall of key management steps, suggesting diagnostic possibilities, and providing dose and drug information, cognitive aids may improve clinician performance during such events. In actual clinical practice, however, cognitive aids may be available but inconsistently used. One possibility explaining aid non-use during critical events is a lack of familiarity with how cognitive aids may be helpful. We hypothesized that introduction of critical event cognitive aids along with implementation of cognitive aid resources would change the quantitative incidence of cognitive aid use and qualitative reasons for aid non-use. We surveyed members of an academic anesthesia department before and after implementation of critical event cognitive aid resources.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>All anesthesia clinicians at a single academic medical center were surveyed. <\/jats:p>\n<jats:p>Participants were surveyed both pre- and post-training with a focused program to introduce critical event cognitive aid resources. Incidences of and reasons for cognitive aid use and non-use were collected and analyzed. Survey responses were compared pre- and post-implementation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The response rate was 64.5%. One-hundred eighty-five reasons for non-use were collected before the focused program and 149 after. Overall, 80% of clinicians had encountered at least one critical event during the study period and use of cognitive aids during all reported events was 7%. Six categories of reasons for non-use were identified: \u2018Not Available\u2019, \u2018Not Needed\u2019, \u2018No Time\u2019, \u2018Another Person In Charge\u2019, \u2018Used In Another Way\u2019, \u2018No Reason Given\u2019. After implementation, a decrease in the number of respondents who cited availability and who cited \u2018another person running crisis,\u2019 as reasons for non-use was observed (p\u2009&lt;\u20090.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Implementation of cognitive aids for critical events in an academic anesthesia environment improved the perception of cognitive aid availability and decreased the number of subjects who chose to not use the aid due to another person running the crisis response. Looking at the multiple reasons for cognitive aid non-use may guide implementation, training, and design.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0314774","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T18:32:42Z","timestamp":1740767562000},"page":"e0314774","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Why are critical event checklists not always used in the perioperative setting?: A retrospective survey"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5942-1190","authenticated-orcid":true,"given":"Anna","family":"Clebone","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Allan","family":"Klock Jr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen Y.","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery","family":"Tung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"issue":"4","key":"pone.0314774.ref001","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1097\/ALN.0b013e31819b5bdc","article-title":"Epidemiology of anesthesia-related mortality in the United States, 1999-2005","volume":"110","author":"G Li","year":"2009","journal-title":"Anesthesiology"},{"issue":"1","key":"pone.0314774.ref002","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1213\/ANE.0000000000002286","article-title":"More than a tick box: medical checklist development, design, and use","volume":"126","author":"BK Burian","year":"2018","journal-title":"Anesth Analg"},{"issue":"4","key":"pone.0314774.ref003","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1097\/ALN.0000000000000153","article-title":"Anesthesia-related cardiac arrest","volume":"120","author":"SJ Ellis","year":"2014","journal-title":"Anesthesiology"},{"key":"pone.0314774.ref004","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.resuscitation.2013.08.029","article-title":"Cardiac arrest in the operating room: a 5-year study from a tertiary teaching hospital","volume":"84","author":"O Pereira","year":"2013","journal-title":"Resuscitation"},{"key":"pone.0314774.ref005","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.resuscitation.2018.06.005","article-title":"Adherence to advanced cardiovascular life support (ACLS) guidelines during in-hospital cardiac arrest is associated with improved outcomes","volume":"129","author":"K Honarmand","year":"2018","journal-title":"Resuscitation"},{"issue":"1","key":"pone.0314774.ref006","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.resuscitation.2013.09.019","article-title":"The effect of adherence to ACLS protocols on survival of event in the setting of in-hospital cardiac arrest","volume":"85","author":"MD McEvoy","year":"2014","journal-title":"Resuscitation"},{"issue":"7562","key":"pone.0314774.ref007","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1038\/523516a","article-title":"Hospital checklists are meant to save lives - so why do they often fail?","volume":"523","author":"E Anthes","year":"2015","journal-title":"Nature"},{"issue":"5","key":"pone.0314774.ref008","first-page":"212","article-title":"Emergency manual implementation: can brief simulation-based or staff trainings increase familiarity and planned clinical use?","volume":"41","author":"SN Goldhaber-Fiebert","year":"2015","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"5","key":"pone.0314774.ref009","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1097\/ALN.0000000000003947","article-title":"The evolution, current value, and future of the American society of anesthesiologists physical status classification system","volume":"135","author":"B Horvath","year":"2021","journal-title":"Anesthesiology"},{"issue":"1","key":"pone.0314774.ref010","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1213\/ANE.0000000000002286","article-title":"More than a tick box: medical checklist development, design, and use","volume":"126","author":"BK Burian","year":"2018","journal-title":"Anesth Analg"},{"issue":"3","key":"pone.0314774.ref011","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1213\/ANE.0000000000001746","article-title":"The development and implementation of cognitive aids for critical events in pediatric anesthesia: the society for pediatric anesthesia critical events checklists","volume":"124","author":"A Clebone","year":"2017","journal-title":"Anesth Analg"},{"issue":"2","key":"pone.0314774.ref012","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1213\/ANE.0000000000003578","article-title":"Emergency manual implementation in a large academic anesthesia practice: strategy and improvement in performance on critical steps","volume":"128","author":"SJ Gleich","year":"2019","journal-title":"Anesth Analg"},{"issue":"3","key":"pone.0314774.ref013","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1111\/aas.13503","article-title":"The effect of cognitive aid design on the perceived usability of critical event cognitive aids","volume":"64","author":"A Clebone","year":"2020","journal-title":"Acta Anaesthesiol Scand"},{"issue":"6","key":"pone.0314774.ref014","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1007\/s12630-019-01325-8","article-title":"Matching design to use: a task analysis comparison of three cognitive aid designs used during simulated crisis management","volume":"66","author":"A Clebone","year":"2019","journal-title":"Can J Anaesth"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314774","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T18:32:58Z","timestamp":1740767578000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0314774"}},"subtitle":[],"editor":[{"given":"Zyad J.","family":"Carr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,2,28]]},"references-count":14,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0314774","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,28]]}}}