The development of a scoring tool for the measurement of performance in managing hypotension and intra-operative cardiac arrest during spinal anaesthesia for caesarean section

  • Garth Horsten University of KwaZulu-Natal
  • Robert Wise University of KwaZulu-Natal
  • Shaun Ramroop University of KwaZulu-Natal
  • Reitze Rodseth University of KwaZulu-Natal
Keywords: anaesthesia spinal, caesarean section, internship, residency, simulation, simulator

Abstract

Background: At level one hospitals in South Africa a high annual number of maternal deaths occur due to the unrecognised/untreated complications of spinal anaesthesia. The authors developed a clinical scenario and scoring system to measure intern performance in managing hypotension and cardiac arrest during spinal anaesthesia for caesarean section on a human patient simulator. This system was then subjected to tests of validity and reliability. Methods: The simulator-based clinical scenario was developed by two specialist anaesthesiologists. A modified Delphi technique was used to achieve consensus among 10 anaesthetic specialists regarding a standardised scoring system. A total of 20 medical officers with a Diploma in Anaesthesiology and 20 interns completed the scenario and were scored by two senior anaesthesiologists. Results: Medical officers scored an average of 252 and 246 points, whereas interns scored an average of 216 and 215 points (p = 0.005 and p = 0.013, respectively). The scoring instrument demonstrated high inter-assessor reliability with an intra-class correlation coefficient of 0.983. Conclusions: The scoring tool was shown to be valid and reliable. It offers a standardised assessment process and may be used to refine institutional intern training programmes, with a view to improving anaesthesia skills in community service medical officers.

Author Biographies

Garth Horsten, University of KwaZulu-Natal
Discipline of Anaesthesia and Critical Care Inkosi Albert Luthuli Central Hospital Nelson R. Mandela School of Medicine University of KwaZulu-Natal Durban South Africa
Robert Wise, University of KwaZulu-Natal
Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management Pietermaritzburg; and Clinical Unit Critical Care Edendale Hospital Pietermaritzburg; and Discipline of Anaesthesia and Critical Care Perioperative Research Group University of KwaZulu-Natal Durban
Shaun Ramroop, University of KwaZulu-Natal
Department of Statistics and Biometry School of Mathematics, Statistics and Computer Science University of KwaZulu-Natal Durban
Reitze Rodseth, University of KwaZulu-Natal
Pietermaritzburg Metropolitan Department of Anaesthetics, Critical Care and Pain Management Pietermaritzburg; and Discipline of Anaesthesia and Critical Care Perioperative Research Group University of KwaZulu-Natal Durban; and Clinical Unit: Anaesthesia Greys Hospital Pietermaritzburg; and Outcomes Research Consortium Cleveland Clinic Cleveland Ohio
Section
Research Articles