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首页> 外文期刊>The Journal of Graduate Medical Education >Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients
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Developing a Tool to Assess Placement of Central Venous Catheters in Pediatrics Patients

机译：开发一种评估中央静脉导管在儿科患者中放置的工具

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Background?Pediatric critical care medicine requires the acquisition of procedural skills, but to date no criteria exist for assessing trainee competence in central venous catheter (CVC) insertion.;Objective?The goal of this study was to create and demonstrate validity evidence for a direct observation tool for assessing CVC insertion.;Methods?Ten experts used the modified Delphi technique to create a 15-item direct observation tool to assess 5 scripted and filmed simulated scenarios of CVC placement. The scenarios were hosted on a dedicated website from March to May 2013, and respondents recruited by e-mail completed the observation tool in real time while watching the scenarios. The goal was to obtain 50 respondents and a total of 250 scenario ratings.;Results?A total of 49 pediatrics intensive care faculty physicians (6.3% of 780 potential subjects) responded and generated 188 scenario observations. Of these, 150 (79.8%) were recorded from participants who scored 4 or more on the 5 scenarios. The tool correctly identified the expected reference standard in 96.8% of assessments with an interrater agreement kappa (standard error) = 0.94 (0.07) and receiver operating characteristic = 0.97 (95% CI 0.94–0.99).;Conclusions?This direct observation assessment tool for central venous catheterization demonstrates excellent performance in identifying the reference standard with a high degree of interrater reliability. These assessments support a validity construct for a pediatric critical care medicine faculty member to assess a provider placing a CVC in a pediatrics patient.;What was known and gap Pediatric critical care medicine trainees are expected to become skilled in central venous catheter (CVC) insertion, but to date no criteria exist for assessing trainee competence.;What is new Content experts developed a direct observation tool that was validated with pediatric critical care physicians using simulated scenarios.;Limitations Use of simulated scenarios may reduce the ability to generalize to some real clinical situations.;Bottom line The direct observation assessment showed validity evidence, including high interrater reliability, and has the potential of offering specific feedback on aspects of CVC placement.;Introduction Pediatric critical care medicine (PCCM) fellows need to be skilled in performing bedside procedures, yet no criteria exist for determining competency in performing central venous catheter (CVC) insertion.1 Assessment of learner proficiency usually is based on a global recall rating by supervising faculty, which is difficult to replicate and does not provide specific suggestions for performance improvement. Currently, no assessment tool with supporting evidence of validity exists for direct observational assessment of proficiency at CVC insertion in pediatric intensive care medicine.2 Such tools have been developed for placement in adults, but applying these to the PCCM environment is difficult.3–8 In addition, existing tools typically focus on the technical aspect of procedural competence9–13 and rarely address the knowledge and communication elements of the procedure.14 Simple checklist assessment tools may not adequately identify global performance, and subjective recall ratings are difficult to standardize across a cohort of raters due to interrater variability in the definition of competency.15 Assessment of novel tools to address procedural competence in the clinical environment is time consuming and labor intensive. Gathering validity evidence using a direct observation tool in pediatric intensive care units across the United States would require the training of multiple expert raters, as well as obtaining consent from both the learners and the patients for the enrollment of actual CVC placements, many of which are urgent or emergent. One approach to simplify collection of validity evidence is through the use of simulation technology, which has emerged as an acceptable assessment environment in medica
机译：背景？儿科临界护理医学需要获取程序技能，但迄今为止，不存在用于评估中央静脉导管（CVC）插入的实习能力的标准。目标？本研究的目标是为直接创造和展示有效证据用于评估CVC插入的观察工具。方法？十个专家使用改进的Delphi技术创建一个15项直接观察工具，以评估CVC放置的5个脚本和拍摄的模拟场景。从2013年3月到2013年3月，该方案在专用网站上托管，并通过电子邮件招聘的受访者在观看情景时实时完成观察工具。目标是获得50名受访者，共有250个情景评级。;结果？共有49名儿科重症监护人员医师（6.3％的780个潜在科目）作出回应并产生了188个情景观察。其中，从参加者的参与者记录了150名（79.8％），在5场景中得分4或更多。该工具在96.8％的评估中正确确定了预期参考标准，其中Interrater协议Kappa（标准误差）= 0.94（0.07）和接收器操作特性= 0.97（95％CI 0.94-0.99）。结论？这个直接观察评估工具对于中央静脉导管，表明具有高度Interray可靠性的参考标准的优异性能。这些评估支持儿科关键护理医学教师的有效性构建，以评估将CVC放在儿科患者中的提供者。;所知和差距小儿临界护理医学学员预计将成为中央静脉导管（CVC）插入的技术人员但到目前为止，不存在用于评估实习能力的标准。;新内容专家开发了一种直接观察工具，使用模拟场景与儿科关键护理医师进行了验证的直接观察工具。;限制使用模拟场景可能会降低概括到一些真实的能力临床情境。底线直接观察评估显示有效证据，包括高中安捷工可靠性，并有可能在CVC放置方面提供具体反馈。;引入儿科关键护理医学（PCCM）研究员需要熟练熟练进行床头程序，但没有存在用于执行Centra的能力的标准l静脉导管（CVC）插入.1学习者熟练程度的评估通常是通过监督教师的全球召回评级，这难以复制，并没有提供对绩效改进的具体建议。目前，没有支持有效性证据的评估工具存在直接观察CVC插入熟练程度在儿科密集护理医学中的熟练程度评估.2已经开发了这种工具，以便在成人中进行安置，但将这些工具应用于PCCM环境困难.3-8此外，现有工具通常专注于程序竞争力的技术方面9-13，很少解决程序的知识和通信元素.14简单的清单评估工具可能无法充分识别全球性能，主观召回额定值难以规范由于Interritainer可变异的评估队伍在临床环境中解决程序能力的评估，评估了临床环境中的新颖工具的评估是耗时和劳动力密集的。在美国对小儿科重症监护单位的直接观察工具采集有效性证据将需要培训多个专家评估者，以及从学习者和患者获得同意的同意，以获得实际的CVC展示，其中许多是紧急或紧急。简化有效性证据的一种方法是通过使用仿真技术，它成为Medica中可接受的评估环境

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