A new instrument to assess physician skill at chest tube insertion: the TUBE-iCOMPT

• Published in: Thorax Vol. 70; no. 2; p. 186
• Main Authors: Salamonsen, Matthew R, Bashirzadeh, Farzad, Ritchie, Alexander J, Ward, Helen E, Fielding, David I K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2015
• Subjects: Acquisitions & mergers; Chest Tubes; Clinical Competence; Dissection; Humans; Patients; Process Assessment (Health Care) - methods; Pulmonary Medicine - standards; Reproducibility of Results; Skills; Statistical analysis; Thoracostomy - methods; Thoracostomy - standards; Training; Validity; Variance analysis; Pleural Disease
• ISSN: 0040-6376; 1468-3296; 1468-3296
• DOI: 10.1136/thoraxjnl-2013-204914

Currently no tool exists to assess proceduralist skill at chest tube insertion. As inadequate doctor procedural competence has repeatedly been associated with adverse events, there is a need for a tool to assess procedural competence. This study aims to develop and examine the validity of a tool to assess competency at insertion of a chest tube, using either the Seldinger technique or blunt dissection. A 5-domain 100-point assessment tool was developed inline with British Thoracic Society guidelines and international consensus—the Chest Tube Insertion Competency Test (TUBE-iCOMPT). The instrument was used to assess chest tube insertion in mannequins and live patients. 29 participants (9 novices, 14 intermediate and 6 advanced) were tested by 2 blinded expert examiners on 2 occasions. The tool's validity was examined by demonstrating: (1) stratification of participants according to expected level of expertise (analysis of variance), and (2) test-retest and intertester reliability (intraclass correlation coefficient). The intraclass correlation coefficient of repeated scores for the Seldinger technique and blunt dissection, were 0.92 and 0.91, respectively, for test-retest results, and 0.98 and 0.95, respectively, for intertester results. Clear stratification of scores according to participant experience was seen (p<0.0001). There was no significant difference between scores obtained using mannequins or live patients. This study has validated the TUBE-iCOMPT, which could now be incorporated into chest tube insertion training programmes, providing a way to document acquisition of skill, guide individualised teaching, and assist with the assessment of the adequacy of clinician training.