The PETRA (Perinatal Emergency Team Response Assessment) Scale: A High-Fidelity Simulation Validation Study.

Abstract

The objective of this study was to establish the validity and reliability of a new interdisciplinary teamwork assessment scale, the Perinatal Emergency Team Response Assessment (PETRA), to assess team dynamics during a simulated obstetriccrisis. This observational cohort study was conducted using high-fidelity simulation and multidisciplinary obstetric teams in order to evaluate the validity and reliability of the previously developed PETRA scale for the assessment of teamwork in the management of obstetric crises. Two high-fidelity simulations of preeclampsia and postpartum hemorrhage (PPH) were conducted 50 times; 42 were performed by multidisciplinary teams and eight (four "good," four "poor") were performed by actors. Five raters used the PETRA tool to assess the simulation video recordings. Three additional raters assessed each performance without the use of PETRA as "good" or "poor" in order to provide an overall rating (referred to as the standardized score). The primary outcome measure was the PETRA score. Cronbach's alpha and intra-class correlation coefficients (2,1) with 95% CIs were calculated to examine internal consistency of the scale and level of agreement among raters, respectively. Construct validity was established by comparing the assessments of the raters with the standardized scores. Generalizability theory analysis was performed to demonstrate PETRA's reliability and to investigate the sources of variation in scores. The simulated emergencies were performed by 119 participants. There was overall high consistency (Cronbach's alpha [95% CI] 0.984 [0.981 to 0.987]) and moderate agreement (intra-class correlation coefficients [95% CI] 0.49 [0.35 to 0.63]) among raters. Significantly higher PETRA scores (mean [standard deviation]) were recorded with "good" versus "poor" performing teams (real scenarios 3.8 [0.7] vs. 2.9 [0.7]; P < 0.001; acted scenarios 4.7 [0.5] vs. 2.2 [0.7]; P < 0.001), suggesting strong construct validity. The overall PETRA scores were not different between the PPH (3.7 [0.7]) and preeclampsia (3.7 [0.8]) scenarios (P= 0.49). Generalizability coefficients were 0.83 for PPH and 0.76 for preeclampsia. PETRA is a valid and reliable scale that may be a valuable tool in the assessment and training of multidisciplinary teams in their management of obstetric crises.