Validity and reliability of an objective structured assessment tool for performance of ultrasound-guided regional anaesthesia.

BACKGROUND: We examined the validity and reliability of the previously developed criterion-referenced assessment checklist (AC) and global rating scale (GRS) to assess performance in ultrasound-guided regional anaesthesia (UGRA). METHODS: Twenty-one anaesthetists' single, real-time UGRA procedures (total: 21 blocks) were assessed using a 22-item AC and a 9-item GRS scored on 3-point and 5-point Likert scales, respectively. We used one-way analysis of variance to compare the assessment scores between three groups (Group 1: ≤30 blocks in the preceding year; Group 2: 31-100; and Group 3: >100). The concurrent validity was evaluated using Pearson's correlation (r). We calculated Type A intra-class correlation coefficient using an absolute-agreement definition in two-way random effects model, and inter-rater reliability using an absolute agreement between raters. The inter-item consistency was assessed by Cronbach's α. RESULTS: The greater UGRA experience in the preceding year was associated with better AC [F (2, 18) 12.01; P<0.001] and GRS [F (2, 18) 7.44; P=0.004] scores. There was a strong correlation between the mean AC and GRS scores [r=0.73 (P<0.001)], and a strong inter-item consistency for AC (α=0.94) and GRS (α=0.83). The intra-class correlation coefficient (95% confidence interval) and inter-rater reliability (95% confidence interval) for AC were 0.96 (0.95-0.96) and 0.91 (0.88-0.95), respectively, and 0.93 (0.90-0.94) and 0.80 (0.74-0.86) for GRS. CONCLUSIONS: Both assessments differentiated between individuals who had performed fewer (≤30) and many (>100) blocks in the preceding year, supporting construct validity. It also established concurrent validity and overall reliability. We recommend that both tools can be used in UGRA assessment.

Cost comparison of re-usable and single-use fibrescopes in a large English teaching hospital.

A number of studies in the U.S.A. and mainland Europe have described the costs of fibreoptic tracheal intubation. However, no such data from the UK appear available. We performed a cost assessment of fibreoptic intubation, using re-usable (various devices from Olympus, Acutronic and Karl Storz) and single-use (Ambu aScope) fibrescopes, at the Queens Medical Centre, Nottingham, U.K., between 1 January 2009 and 31 March 2014. The total annual cost of fibreoptic intubation with re-usable fibrescopes was £46,385. Based on 141 fibreoptic intubations per year, this equated to £329 per use, an average dominated by repair/maintenance costs (43%) and capital depreciation costs (42%). In comparison, the total annual cost of using single-use fibrescopes for the same work would have been around £200 per use. The analysis enabled us to develop a generic model, wherein we were able to describe the relationship between total cost of use vs number of uses for a fibrescope. An 'isopleth' was identified for this relationship: a line that joined all the points where the cost of re-usable vs single-use fibrescopes was equal. It appears cheaper to use single-use fibrescopes at up to 200 fibreoptic intubations per year (a range commensurate with normal practice) even when the repair rate for re-usable fibrescopes is low. Any centre, knowing its fibrescope use and repair rate, can plot its data similarly to help ascertain which of the re-usable or single-use fibrescope represents better value.