Application of the ABCDE method by residents in clinical practice: a prospective observational study

Abstract Background: The ABCDE method is used to identify and treat life-threatening problems of emergency department (ED) patients. How often and how residents apply the ABCDE method in clinical practice is not extensively investigated. This study aimed to investigate the number and quality of ABCDE method applications in the ED. Methods: In this prospective observational study, we observed residents during 3 phases in which residents were either unaware (blind phases 1 and 3) or aware (open phase 2) of the observational aims. The number and quality of ABCDE method applications was scored. Quality was measured using several scores, including the Completeness Score (0-100%) and Competency Scale (1-7). Results: We analysed 103 ED patient assessments in an 8-week period. The ABCDE method was applied in 35.9% of patients and when applied, the method was 72.9% complete. The ABCDE method was applied more often when patients were triaged as very urgent than when triaged as less urgent (63.2% vs. 29.8%, p=0.008). When residents were openly observed, the method was applied more often than in blind phase 1 (57.1% vs.17.0%, OR 6.3 (95% CI: 2.1-19.0), p=0.001), more completely (79.5% vs. 67.0%, p=0.015), and with higher scores on the Competency Scale (6.0 vs.5.3, p=0.001). Conclusions: Residents apply the ABCDE method in one third of patients in the ED, and more often when being aware of the observation. In addition, the quality was better when being aware of the observation. Awareness of being observed and the severity of illness were triggers to apply the ABCDE method.