Video-Assisted Cognitive Task Analysis to Determine Best Practice in ECMO Centrifugal Pump Change

First Author(s)

• 

  Jennifer Diep

  Childrens Hospital Los Angeles
  Los Angeles, California

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• MM

  Michael Minneti, MEd.

  Education Specialist
  N/A, United States

  Disclosure information not submitted.
• TC

  Todd Chang

  Pediatric Emergency Medicine Physician
  Children's Hospital Los Angeles
  Los Angeles, California, United States

  Disclosure information not submitted.
• LN

  Lara Nelson, MD

  Pediatric Cardiac Intensivist
  Children's Hospital Los Angeles
  Los Angeles, California, United States

  Disclosure information not submitted.
• AR

  Alyssa Rake, MD

  Pediatric Intensivist
  Children's Hospital Los Angeles, United States

  Disclosure information not submitted.

Title: Video-Assisted Cognitive Task Analysis To Determine Best Practice In ECMO Centrifugal Pump Change

Introduction/Hypothesis: As pediatric critical care prioritizes patient safety and minimizes invasive procedures, procedural opportunities for learners become sparse. This necessitates a transition from the traditional apprenticeship model to procedural curricula based on experts’ recall of the critical steps necessary to perform a task. Unfortunately, experts often unknowingly neglect to communicate task minutiae and cognitive decisions to novices. Cognitive task analysis (CTA) is a systematic educational method to identify the conscious and unconscious knowledge and skills with which experts complete complex tasks. This study used video-assisted CTA (VA-CTA) with subject matter experts (SMEs) to identify the critical steps for extracorporeal membrane oxygenation (ECMO) centrifugal pump change. The final educational goal is to develop a best practice procedural rubric for a simulation-based ECMO centrifugal pump change curriculum.

Methods:  ECMO SMEs consisting of perfusionists and ECMO specialists voluntarily participated in the study. SMEs were video recorded performing a pump change using an ECMO simulator at an academic children’s hospital (session 1). Session 1 video provided reference for the audio recorded CTA (session 2) that followed. Two study members independently coded session 2 transcriptions. Subsequent coding analysis ensured inter-rater reliability. Final data analysis identified SMEs’ discrete actions and decisions for ECMO centrifugal pump change.

Results:  VA-CTA yielded differences for several steps of the ECMO centrifugal pump change both among SMEs and as compared to the existing institutional curriculum. Differences included pump/tubing arrangement, priming/de-airing, recruiting an assistant, cleaning, and applying cross clamps.

Conclusions:  The use of VA-CTA to assess ECMO procedural processes is novel. While SMEs identified many similar critical steps for ECMO centrifugal pump change, VA-CTA did demonstrate differences between experts and existing guidelines. Next steps include adjudicating these differences to define a final procedural and simulation-based educational rubric.