Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers

Table 3 Multivariable analysis to identify predictors of regular use of cognitive aids during appropriate OR crises (successful implementation reported)

Predictor	Odds ratio	95% confidence interval	p value
Number of implementation steps (out of 8)^†	1.57	1.31–1.87	< 0.0001*
Number of operating rooms			0.0203*
0–4	4.11	1.66–10.18	0.0092*
5–15	2.20	1.01–4.80	0.6446
16–30	1.69	0.73–3.91	0.5367
≥ 30	Reference group	n/a	n/a
Number of other ways in which tool was used (out of 4)^‡	1.41	1.03–1.92	0.0328*
Enabled tool implementation—support of my department or institution leadership	3.26	1.80–5.91	< 0.0001*
Enabled tool implementation—time to train staff	3.75	1.24–11.28	0.0189*
Challenge to implement—clinical providers resisted using tool	0.18	0.08–0.38	< 0.0001*
Challenge to implement—absence of committed implementation champion	0.44	0.23–0.84	0.0126*
Challenge to implement—found content or design of tool unsatisfactory	0.11	0.02–0.61	0.0112*

c-statistic = 0.849
*Significant at alpha = 0.05
^†The implementation step score was calculated by summing the following yes/no questions: (1) Has the tool been presented at staff, physician, or departmental meetings, (2) Has your facility established a multidisciplinary team to review the tool, (3) Did you customize the tool to your facility’s local context, (4) Did your facility pilot test the tool, (5) Has your facility trained people working in the use of the tool, (6) Does your facility provide ongoing/routine training on the effective use of this tool, (7) Does your facility monitor the use of the tool, and (8) Has your facility expanded the use of the tool to other areas in the hospital where anesthesia is being administered
^‡The number of ways in which tool is used score was calculated by summing the following yes/no questions: (1) emergency drills in the OR or simulation center, (2) to prepare for a complex case, (3) to debrief after a critical event, and (4) educational review

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