145 Assessment of Current ACLS Certification: An Unmet Need

Abstract

Robust assessment is a crucial component in Advanced Life Support (ALS) training to determine whether participants have achieved learning objectives with little or no variation in their overall outcomes. We aimed to analyze the consistency of current checklist evaluation with minimum passing score (MPS) approach to the pass/fail judgments by comparison with the adherence of several important parameters for guideline recommendations. Video records and formal checklist-based test results of cardiac arrest test scenarios for ACLS certification exam at several hospitals in Taipei, Taiwan during July, 2015 to Sep, 2016 were examined. Cases were excluded if any of the above data was missing. For the study interest, three objective parameters were measured via video review and were used for evaluation: percentage of compression free no-flow fraction (NFF), time to initiating chest compression and time to initiating defibrillation if applicable. All analyses were performed using Statistical Analysis Software for Windows, version V.9.4 (SAS Institute Inc, Cary, NC). A total of 185 scenarios were eligible for final analysis. While time to initiating chest compression was no difference between “checklist fail (Fail) group” and “checklist pass (Pass) group,” time to first shock delivery, if applicable, was significantly longer in the Fail group than that in the Pass group,” 84±29 (Mean±SD) seconds and 63±21 seconds, respectively. In addition, NFF was also significantly higher in Fail group (30±8 %) than that in Pass group (37±8 %). Although the statistical significance “between” groups were observed in both time to first shock and NFF, notice in the graph that “within” groups variation of these key parameters was widely spread. Rater observation using checklist-based tool could capture important tasks in assessing cardiac arrest scenarios; however, it can overlook many important survival-related parameters with the potential of influencing evaluation accuracy. Continues rater training and standardization and the development of valid tools for real-time assessment adjunct are essential toward more consistent outcome measures.View Large Image Figure ViewerDownload Hi-res image Download (PPT)