Lack of Benefit of Adjusting Adaptively Daily Invitations for the Evaluation of the Quality of Anesthesiologists' Supervision and Nurse Anesthetists' Work Habits.

Abstract

Introduction Whenever a department implements the evaluation of professionals, a reasonable operational goal is to request as few evaluations as possible.In anesthesiology, evaluations of anesthesiologists (by trainees) and nurse anesthetists (by anesthesiologists) with valid and psychometrically reliable scales have been made by requesting daily evaluations of the ratee's performance on the immediately preceding day. However, some trainees or nurse anesthetists are paired with the same anesthesiologist for multiple days of the same week. Multiple evaluations from the same rater during a given week may contribute little incremental information versus one evaluation from that rater for the week. We address whether daily evaluation requests could be adjusted adaptively to be made once per week, hopefully substantively reducing the number of evaluation requests. Methods Every day since 1 July 2013 at the studied department, anesthesia residents and fellows have been requested by email to evaluate anesthesiologists' quality of supervision provided during the preceding day using the De Oliveira Filho supervision scale. Every day since 29 March 2015, the anesthesiologists have been requested by email to evaluate the work habits of the nurse anesthetists during the preceding day. Both types of evaluations were made for interactions throughout the workday together, not for individual cases. The criterion for an electronic request to be sent is that the pair worked together for at least one hour that day.The current study was performed using evaluations of anesthesiologists' supervision and nurse anesthetists' work habits through 30June 2023. Results If every evaluation request were completed by trainees on the same day it was requested, trainees would have received 13.5% fewer requests toevaluate anesthesiologists (9367/69,420), the maximum possible reduction. If anesthesiologists were to do the same for their evaluations of nurse anesthetists, the maximum possible reduction would be 7.1% fewer requests (4794/67,274). However, because most evaluations were completed after the day of the request (71%, 96,451/136,694), there would be fewer requests only if the evaluation were completed before or on the day of the next pairing. Consequently, in actual practice, there would have been only 2.4% fewer evaluation requests to trainees and 1.5% fewer toanesthesiologists, both decreases being significantly less than 5% (both adjusted P <0.0001). Among the trainees' evaluations of faculty anesthesiologists, there were 1.4% with very low scores, specifically, a mean score of less than three out of four (708/41,778). Using Bernoullicumulative sum (CUSUM) among successive evaluations, 72 flags were raised over the 10 years. Among those, there were 36% with more than one rater giving an exceptionally low score during the same week (26/72). There were 97% (70/72) with at least one rater contributing more than one score to the recent cumulative sum. Conclusion Conceptually, evaluation requests could be skipped if a rater has already evaluated the ratee that week during an earlier day working together. Our results show that the opportunity for reductions in evaluation requests is significantly less than 5%. There may also be impaired monitoring for the detection of sudden major decreases in ratee performance. Thus, the simpler strategy of requesting evaluations daily after working together is warranted.