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

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.