Development of an instrument for the evaluation of advanced life support performance

Assessing advanced life support (ALS) competence requires validated instruments. Existing instruments include aspects of technical skills (TS), non-technical skills (NTS) or both, but one instrument for detailed assessment that suits all resuscitation situations is lacking. This study aimed to develop an instrument for the evaluation of the overall ALS performance of the whole team.

This instrument development study had four phases. First, we reviewed literature and resuscitation guidelines to explore items to include in the instrument. Thereafter, we interviewed resuscitation team professionals (n = 66), using the critical incident technique, to determine possible additional aspects associated with the performance of ALS. Second, we developed an instrument based on the findings. Third, we used an expert panel (n = 20) to assess the validity of the developed instrument. Finally, we revised the instrument based on the experts' comments and tested it with six experts who evaluated 22 video recorded resuscitations.

The final version of the developed instrument had 69 items divided into adherence to guidelines (28 items), clinical decision-making (5 items), workload management (12 items), team behaviour (8 items), information management (6 items), patient integrity and consideration of laymen (4 items) and work routines (6 items). The Cronbach's α values were good, and strong correlations between the overall performance and the instrument were observed.

The instrument may be useful for detailed assessment of the team's overall performance, but the numerous items make the use demanding. The instrument is still under development, and more research is needed to determine its psychometric properties.