TY  - JOUR
A1  - Kurrek, Matt M.
A1  - Morgan, Pamela
A1  - Howard, Steven
A1  - Kranke, Peter
A1  - Calhoun, Aaron
A1  - Hui, Joshua
A1  - Kiss, Alex
T1  - Simulation as a New Tool to Establish Benchmark Outcome Measures in Obstetrics
JF  - PLoS ONE
N2  - Background 
There are not enough clinical data from rare critical events to calculate statistics to decide if the management of actual events might be below what could reasonably be expected (i.e. was an outlier). 

Objectives 
In this project we used simulation to describe the distribution of management times as an approach to decide if the management of a simulated obstetrical crisis scenario could be considered an outlier. 

Design 
Twelve obstetrical teams managed 4 scenarios that were previously developed. Relevant outcome variables were defined by expert consensus. The distribution of the response times from the teams who performed the respective intervention was graphically displayed and median and quartiles calculated using rank order statistics. 

Results 
Only 7 of the 12 teams performed chest compressions during the arrest following the 'cannot intubate/cannot ventilate' scenario. All other outcome measures were performed by at least 11 of the 12 teams. Calculation of medians and quartiles with 95% CI was possible for all outcomes. Confidence intervals, given the small sample size, were large. 

Conclusion 
We demonstrated the use of simulation to calculate quantiles for management times of critical event. This approach could assist in deciding if a given performance could be considered normal and also point to aspects of care that seem to pose particular challenges as evidenced by a large number of teams not performing the expected maneuver. However sufficiently large sample sizes (i.e. from a national data base) will be required to calculate acceptable confidence intervals and to establish actual tolerance limits.
KW  - performance
KW  - anesthesiologists
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151646
VL  - 10
IS  - 6
ER  -