Augmented Reality in Enhancing Operating Room Crisis Checklist Adherence (Preprint)

BACKGROUND Effective crisis management in operating rooms (OR) is crucial for patient safety. Despite their benefits, adherence to OR crisis checklists is often limited, highlighting the need for innovative solutions. OBJECTIVE To evaluate the efficacy of augmented reality (AR)-enhanced checklists compared with traditional paper checklists and no checklist scenarios in improving protocol adherence during simulated OR crises. METHODS Design: A randomized comparative efficacy study comparing the utility of AR, paper, and no checklists using four validated simulated OR crises scenarios: asystolic cardiac arrest, air embolism, unexplained hypotension/hypoxia, and malignant hyperthermia. Setting: The study took place in a simulated OR setting, and has applicability to the standard procedures in OR, critical care units, and urgent care scenarios in the emergency department. Participants: Fifty Professionals including 24 anesthesiologists, 24 nurses, 1 surgeon, and 1 scrub nurse from two academic hospitals formed 24 OR teams. Main Outcomes and Measures: The primary outcome measured was the rate of failure to adhere (FTA) to critical actions during simulated OR crises. Adherence was determined using retrospective video analysis involving 595 key processes evaluated across 24 surgical teams. Interrater reliability was assessed using Cohen's kappa. Secondary outcomes included cognitive load, as measured by the low-frequency/high-frequency (LF/HF) ratio of heart rate variability and checklist usability. RESULTS The AR checklist group showed a significantly lower FTA rate (mean=15.10%, SD = 5.77%) compared to the paper checklist (mean= 8.32%, SD = 5.65%) and the no checklist group (mean =29.81%, SD = 5.59%). The AR checklist also resulted in a higher LF/HF ratio for anesthesiologists, showing a potential increase in the level of cognitive load. Survey data indicated positive reception for both AR and paper checklists. CONCLUSIONS These results suggest that AR checklists could offer a viable method for enhancing adherence to critical care protocols, although further research is needed to fully assess their impact on clinical outcomes and to address any associated increase in cognitive load.