Annals of Surgery

Skip Navigation LinksHome > May 2014 - Volume 259 - Issue 5 > Improving Surgical Ward Care: Development and Psychometric P...
Annals of Surgery:
doi: 10.1097/SLA.0000000000000451
Original Articles

Improving Surgical Ward Care: Development and Psychometric Properties of a Global Assessment Toolkit

Hull, Louise PhD*; Birnbach, David MD, MPH*,†; Arora, Sonal PhD*; Fitzpatrick, Maureen MSN, ARNP; Sevdalis, Nick PhD*

Supplemental Author Material
Collapse Box


Objective: To develop a toolkit that covers the clinical, nontechnical, and empathic skills required for effective, safe surgical ward care.

Background: Despite the explosion of interest in patient safety, little attention has been placed on the skill set required for safe and effective surgical ward care. Currently, there is a lack of a systematic approach to improving ward care via assessing and improving residents' ward care skills.

Methods: A comprehensive evidence-based and expert-derived toolkit was developed, including a novel clinical checklist for ward care (Clinical Skills Assessment for Ward Care: C-SAW-C); a novel team assessment scale for wards rounds (Teamwork Skills Assessment for Ward Care: T-SAW-C); and a revised version of a physician-patient interaction scale (Physician-Patient Interaction Global Rating Scale: PP-GIS). Interassessor reliability (κ, intraclass correlation), internal consistency (Cronbach α), and convergent validity (Pearson r correlations) were evaluated statistically in 38 simulated scenarios (during which a patient rapidly deteriorated) involving 185 residents.

Results: Excellent interassessor reliability was obtained for C-SAW-C [median κ = 0.89; median intraclass correlation coefficient (ICC) = 0.94], T-SAW-C (median ICC = 0.99), and the revised PP-GIs (κ = 1.00; ICC = 0.98 or higher). Internal consistency was also very high for all team skills assessed by T-SAW-C (Cronbach α range 0.87–0.94 across 6 skills) and the revised PP-GIS (Cronbach α = 0.96)—all P's < 0.001. Significant positive correlations were obtained between the 3 assessments (r = 0.73–0.92, P < 0.001) thus showing evidence for convergent validity.

Conclusions: We developed a toolkit that captures comprehensively the skills that are required for safe and effective ward care, including the high-risk situation where a patient decompensates. The toolkit offers a systematic evaluation of the quality and safety of surgical ward care and can be used to train and debrief residents' skills and performance.

© 2014 by Lippincott Williams & Wilkins.


Article Tools


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.