Abstract
ObjectiveTo evaluate whether responses to dynamic case-vignettes accurately reflect actual practices in complex emergency situations. We hypothesized that when obstetricians were faced with vignette of emergency situation identical to one they previously managed, they would report the management strategy they actually used. On the other hand, there is no reason to suppose that their response to a vignette based on a source case managed by another obstetrician would be the same as the actual management.MethodsA multicenter vignette-based study was used in 7 French maternity units. We chose the example of severe postpartum hemorrhage (PPH) to study the use of case-vignettes for assessing the management of complex situations. We developed dynamic case-vignettes describing incidents of PPH in several steps, using documentation in patient files. Vignettes described the postpartum course and included multiple-choice questions detailing proposed clinical care. Each participating obstetrician was asked to evaluate 4 case-vignettes: 2 directly derived from cases they previously managed and 2 derived from other obstetricians’ cases. We compared the final treatment decision in vignette responses to those documented in the source-case by the overall agreement and the Kappa coefficient, both for the cases the obstetricians previously managed and the cases of others.ResultsThirty obstetricians participated. Overall agreement between final treatment decisions in case-vignettes and documented care for cases obstetricians previously managed was 82% (Kappa coefficient: 0.75, 95% CI [0.62–0.88]). Overall agreement between final treatment decisions in case-vignettes and documented care in vignettes derived from other obstetricians’ cases was only 48% (Kappa coefficient: 0.30, 95% CI [0.12–0.48]). Final agreement with documented care was significantly better for cases based on their own previous cases than for others (p<0.001).ConclusionsDynamic case-vignettes accurately reflect actual practices in complex emergency situations. Therefore, they can be used to assess the quality of management in these situations.
Highlights
The first step in improving clinical practices is assessing their quality, preferably by a simple, feasible, and accurate method
Peabody et al [7,8] have concluded that vignettes are a valid tool for measuring the quality of clinical practice, compared with standardized patients or chart abstraction
We focused on the situation of severe postpartum hemorrhage (PPH) because it is a common, complex emergency situation that occurs in about 1 to 2% of deliveries in developed countries [18,19]
Summary
The first step in improving clinical practices is assessing their quality, preferably by a simple, feasible, and accurate method. Several methods have been used: standardized patients (trained actors), high fidelity simulation, chart abstraction, clinical audits, and clinical case vignettes. Peabody et al [7,8] have concluded that vignettes are a valid tool for measuring the quality of clinical practice, compared with standardized (actor) patients or chart abstraction. They measure quality of care better than chart abstraction does. It is easier to control case-mix variation in vignettes than in data sets They have been widely used across countries, health care systems, and specialties [11,12,13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
