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A Modified Delphi Method to Create a Scoring System for Performance in Maternal Cardiac Arrest
Abstract Number: T 7
Abstract Type: Original Research
Background: Maternal cardiac arrest is a rare but often fatal emergency. Studies have found clinicians to be poor at resuscitating pregnant patients(1,2). Beyond the American Heart Association guidelines(3) no accepted tool exists to assess the performance of practitioners managing these patients. Therefore, the authors used a modified Delphi method to capture expert judgment to create a checklist of tasks practitioners should perform during the first five minutes of a maternal cardiac arrest(4). The authors’ objective was to create a weighted scoring system that could be used to quantitatively measure proper practitioner performance during such emergencies.
Methods: After reviewing the literature and pooling internal clinician opinions, the authors created a list of tasks thought to be essential for management of maternal cardiac arrest. The list was then distributed to seven recognized experts including obstetricians, anesthesiologists, and nurses to render judgments related to appropriate management of maternal cardiac arrest. Within each round, experts ranked tasks on a scale from 1 through 5 (1 least important and 5 most important). Experts could also suggest items to add, delete, or change. Medians were calculated based on experts’ ratings and consensus was defined a priori as 80% exact agreement.
Results: The initial list contained 41 tasks. Three rounds were required to achieve consensus resulting in a checklist of 45 tasks, 28 of them with 80% exact agreement. Round One had a total of 41 items, and included 5 items with 80% exact agreement with rating of “3” or above, 13 without 80% exact agreement that were rated as “3” or above, and 23 items without a majority consensus. Eight items were suggested to be added by experts. Results from Round Two included 24 items with 80% exact agreement that were rated as “3” or above, 13 items rated as “3” or above but without 80% exact agreement, 1 item that 80% of experts decided to remove, and 11 items without majority consensus. Two items were suggested to be added. Round Three results included 28 items with 80% exact agreement and 17 items rated as “3” or above without 80% exact agreement. One item was removed from the checklist and no consensus was reached on four items.
Conclusion: The modified Delphi technique is a valuable tool to obtain consensus among experts and was used in this study to identify the appropriate management of a maternal cardiac arrest. After numerous modifications, edits, deletions and additions that improved the authors’ original list of tasks, the process resulted in a weighted scoring system that can be used to objectively assess performance. This new weighted scoring system may have applications for education and research of the management of a maternal cardiac arrest.
1. Berkendstadt H. Anesth Analg 2012;115:1122–6.
2. Lipman SS. Am J Obstet Gynecol 2010;203:179.e1-5.
3. Vanden Hoek TL. Circ 2010;122:S829-61.
4. Clayton MJ. Ed Psych 1997;17(4):373-86.