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High-fidelity simulation to evaluate an Interdisciplinary Teamwork Assessment Scale in obstetric crisis management
Abstract Number: T-54
Abstract Type: Original Research
Introduction: The Joint Commission has identified failures in human factors, communication, leadership and assessment as the most frequent root causes of sentinel events . Since these elements are critical in obstetric crisis management, development of evaluated training programs and assessment tools is essential . The objective of this study was to develop a valid and reliable interdisciplinary teamwork assessment scale (ITAS) to assess team dynamics during a simulated obstetric crisis.
Methods: This prospective, observational study developed a 5-point ITAS (34 items) using a modified Delphi technique to establish face and content validity. Two high fidelity simulations of preeclampsia (PE) and postpartum hemorrhage (PPH) were conducted a total of 50 times [8 (4 good, 4 poor) and 42 were performed by actors and multidisciplinary teams, respectively]. Five anesthesia and obstetric experts used the ITAS tool to assess the simulation video recordings. Two additional anesthesia experts rated each performance as good/intermediate and poor, without the use of ITAS, to establish a “gold” standard. A procedural checklist of expected actions was also completed. Cronbach’s α and intraclass correlation coefficient, ICC (2,1) were calculated to examine consistency and level of agreement between raters, respectively. Construct validity was established by comparing the ratings of the 5 experts with the 2 gold standard experts. The primary outcome was the ITAS score.
Results: A total of 119 physicians/nurses participated in simulations. There was overall high consistency (Cronbach’s α=0.98) and moderate agreement [ICC (95%CI)=0.49 (0.35, 0.63)] between raters. Significantly higher scores were seen in good/intermediate than poor performing teams (real scenarios p<0.001; acted scenarios p<0.001) suggesting a strong construct validity (Table 1). The overall ITAS scores were not different between PE [3.7 (0.8)] and PPH [3.7 (0.7)] (p>0.05). The scores of procedural skills were 74.3 % (8.3) for PE and 78.8 % (9.5) for PPH.
Discussion: We have established the reliability and validity of ITAS for use in simulated multidisciplinary obsteric settings. We found that our teams performed at a satisfactory/high level requiring some improvement in skills. This scale has a potential to be used in simulated and real clinical settings to provide feedback and improve teamwork skills.
1. The Joint Commission 2004-14
2. Black et al. 2003;110:837-841