Cumulative Sum learning curves (CUSUM) in basic anaesthesia procedures☆

Ospina, Óscar David Aguirre; Medina, Ángela María Ríos; Marulanda, Mauricio Calderón; Buitrago, Luz María Gómez

doi:10.1097/01819236-201442030-00002

Cited by 9 publications

(13 citation statements)

References 13 publications

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“…On the positive side, the proportion of successful intubations in the study increased steeply in relation to the reported number of previous clinical attempts, consistent with existing evidence that previous intubation experience is associated with subsequent success. 3,7 However, neither our study nor the literature [8][9][10][11] suggests that 20 prior attempts might reliably predict subsequent success, even in a controlled, supervised environment. Given the reduced numbers of tracheal intubations performed for elective surgical cases for which supraglottic airway devices are used, adequate supervised training may not be achieved within the locally recommended 12 40 general anaesthetics required within a two-month anaesthetic internship.…”

Section: Discussioncontrasting

confidence: 61%

Errors and clinical supervision of intubation attempts by the inexperienced

Satyapal

2018

Southern African Journal of Anaesthesia and Analgesia

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Background: Tracheal intubation is an essential skill for anaesthetists and other disciplines that require emergency establishment of a secure airway. Early attempts in patients often meet with failure. Existing publications focus mainly on trainees in emergency settings and highlight the role of experience in success; most recommend prior simulation training. Common factors identified as contributing to difficulty have been difficult airways, emergencies and rapid sequence induction. Early intubation skill development in patients with anticipated straightforward airways in a controlled environment has received little attention. Objectives: This qualitative observational study aimed to identify common difficulties associated with a supervised intubation process by inexperienced personnel in the relatively stress-free conditions of elective surgical procedures in the operating theatre. Methods: Following institutional and ethical approval, participants, supervisors, anaesthetic assistants and patients consented to observation and video-recording of supervised intubations in a Durban teaching hospital. Anonymity and confidentiality were assured. Contemporaneous observations were recorded in theatre, and video-recordings were subsequently reviewed for content. Errors, and interactions between supervisor, assistant and participant, and associated outcomes, were identified. Results: Twenty participants (medical interns and medical, paramedical and nursing students) performing 72 intubations were observed. All participants had prior training using manikins or simulators. There were 61 successful intubations and 11 unsuccessful attempts. Factors associated with failure included unfamiliarity with airway, equipment or process. Process errors included inadequate head positioning, laryngoscope handling and tracheal tube manipulation. Anaesthetic assistants contributed to difficulties in some cases. Supervisor support was either verbal, physical or both. Less experienced supervisors tended to intervene earlier. There was a significant trend for success associated with the reported number of prior successful intubations. A successful intubation within the study was, however, no guarantee of subsequent success. Conclusion: Despite prior simulation training, many participants demonstrated lack of familiarity with the airway, intubation process and equipment. While improved simulation training might partly address these issues, supervision of early clinical intubation attempts needs to be redirected from the process of intubation itself to the process of intubation skills acquisition. A first step would be to ensure that all supervisors and assistants are trained for the latter goal, anticipating common errors and providing standardised conditions for success. The use of video-recording of the events is an invaluable aid to observation and interpretation, and is recommended as an adjunct to further studies of mechanical skills transfer.

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Section: Discussioncontrasting

confidence: 61%

Errors and clinical supervision of intubation attempts by the inexperienced

Satyapal

2018

Southern African Journal of Anaesthesia and Analgesia

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“…Firstly, only one surgeon's performance was evaluated. Significant differences can occur between the CUSUM charts of different individuals when learning a procedure (30). Therefore, although our study showed that it was possible to place the tibial osteotomy within a deviation of 20% of the radius of the saw blade 85% of the time, following approximately 100 procedures, the number of procedures required to obtain this proficiency may vary from surgeon to surgeon.…”

Section: Number Of Stiflesmentioning

confidence: 78%

“…Both methods demonstrated improvement throughout the 231 TPLO procedures. The CUSUM technique allows continued evaluation of performance and has been used to assess the performance of human surgeons, and veterinary surgeons (15,16,29,30). Acceptable failure rates are typically determined from reported complication rates and the unacceptable failure rate is typically set at two to five times the acceptable failure rate (28).…”

Section: Number Of Stiflesmentioning

confidence: 99%

Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide

Craig¹,

Witte²,

Scott³

2017

Vet Comp Orthop Traumatol

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The location of the tibial osteotomy when performing TPLO without an alignment jig and saw guide compared favourably with previously documented use of an alignment jig and saw guide. Whilst the location of the tibial osteotomy has a theoretical impact on the postoperative TPA, other factors appear to be of greater importance. Surgeon experience did not result in significant improvement in accuracy up to 231 procedures.

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“…Cumulative sum analysis is an alternative tool to assess an individual's performance during the conduct of various procedural skills. [ 12 13 14 ] Problems with using cumulative sum analysis (CUSUM) analysis is that it is a statistical method that looks at the outcome rather than at the process of performing procedural skills and there are no nationally agreed definitions for success or failure for a given procedure, and those used in the literature vary greatly. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

Assessment of procedural skills in residents working in a research and training institute: An effort to ensure patient safety and quality control

et al. 2018

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Background:To ensure patient safety, it is important to regularly assess the knowledge and practical skills of anesthesia trainees. This study was conducted to evaluate the competency of the residents and the impact of various corrective measures in the form of didactic lectures and clinical skill demonstrations on the conduct of various procedural skills by the residents.Materials and Methods:Ninety-five junior residents were enrolled in this study. Assessment of competency of 1st, 2nd, and 3rd year residents in performing various procedure skills of anesthesia was done in two stages using procedure specific checklist (PSC) and Global Rating Scales (GRSs). Preliminary results of the first assessment (Score 1) were discussed with the residents; deficiencies were identified and corrective measures suggested by didactic lectures and clinical skill demonstrations which were followed by a subsequent assessment after 3 months (Score 2).Results:There was a statistically significant improvement in the PSC and GRS scores after corrective measures for all the procedural interventions studied. Percentage increase in scores was maximum in 1st year (42.98 ± 6.62) followed by 2nd year (34.62 ± 5.49) and minimum in 3rd year residents (18.06 ± 3.69). The percentage increase of scores was almost similar for all subset of procedural skills; low, intermediate, and high skill anesthetic procedures.Conclusion:For assessment of procedural skills of residents, use of PSC and GRS scores should be incorporated and the same should be used to monitor the impact of various corrective measures (didactic lectures and clinical skill demonstrations) on the conduct of various procedural skills by the resident.

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Cumulative Sum learning curves (CUSUM) in basic anaesthesia procedures☆

Cited by 9 publications

References 13 publications

Errors and clinical supervision of intubation attempts by the inexperienced

Errors and clinical supervision of intubation attempts by the inexperienced

Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide

Assessment of procedural skills in residents working in a research and training institute: An effort to ensure patient safety and quality control

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