American Society of Regional Anesthesia and Pain Medicine August 2018 - 22

Regional Anesthesia Assessment Tools

ultiple tools have been created for assessment of trainee
procedural performance during regional anesthesia tasks,
and published studies evaluating their use can be found in a
number of journals. Assessment tool formats vary, as do the study
designs in which they are used. Some studies seek to create a tool,
others to validate one, and yet others to describe patient or training
outcomes in the context of an assessment.
The following highlighted article summaries showcase a number of
regional assessment tools reported in the anesthesia literature. See
the Table for a list of selected tools. The tools have been grouped
into neuraxial and peripheral block categories. The most frequently
used tools are task-specific checklists, global rating scales, qualitycompromising behaviors, or, most commonly, a combination of two
types of tools.
Task-specific checklists provide the steps of a procedure or task
that an observer expects to see performed in the course of an
encounter. For example, "asking for initial aspiration to rule out
intravascular injection" is a step common to all peripheral nerve
blocks and present in all related checklist tools. The rater expects
the step to occur at the proper time and marks "yes" or "no" to
whether it was performed. Some checklists allow a three-point
rating scale with specification of whether a task was performed
(1) well, (2) poorly, or (3) not at all. Checklists allow more granular
assessment of whether procedural steps occurred but are, as a
result, more procedure-specific and tend to be longer than global

rating scales. Each procedure may
therefore need its own checklist
assessment.
Global rating scales (GRS)
allow assessment of overall
performance or performance on
subtasks, typically on a 5- or
7-point scale. The scales can be
given "anchors," or descriptions
of performance corresponding
Brian F.S. Allen, MD
to different scores. For example,
Assistant Professor
in the category "Instrument
Vanderbilt University School of
Handling," a score of 1 may
Medicine
correspond to repeated awkward
Nashville, Tennessee
movements whereas 3 means
occasional awkward movements,
and a perfect 5 denotes fluid movements without awkwardness.
GRS domains may be more generalizable between different
procedures, with the same instrument potentially used for different
types of assessment. Fewer categories are usually present than
with checklist tools, but a GRS scale does not provide the definitive
"yes" or "no" about a procedural step as a checklist.
Quality-compromising behaviors (QCB) are used in a minority
of performance assessment tools. Instead of categorizing each
step of a procedure, QCB highlight any errors that occur. Whereas

Table: Selected procedural assessment tools for peripheral and neuraxial regional anesthesia techniques.
Assessment author

Year

Type of assessment

# of items

Purpose

Peripheral blocks
Naik

2007

Checklist + GRS

20 + 8

Interscalene, nerve stim

Sites

2007

QCB

UGRA

Sultan

2012

Checklist + GRS

63 + 9

Axillary, UGRA

Cheung

2012

Checklist + GRS

22 + 9

UGRA

Wong

2014

QCB + GRS

31 + 10

UGRA

Watson

2014

9-point scale with behavioral anchors + 2 dichotomous
questions

11 + 2

UGRA

Ahmed

2016

Checklist + QCB

54 + 32

Axillary, UGRA

Birnbach

2002

Checklist

Epidural

Friedman

2006

Checklist + GRS

27 + 7

Epidural

Friedman

2008

Checklist

Asepsis during epidural

Weed

2011

QCB

Spinal

Breen

2011

QCB, GRS, time measures

11 + 6 + 2

Spinal

Neuraxial blocks

Abbreviations: GRS, global rating scale; QCB, quality compromising behaviors; UGRA, ultrasound-guided regional anesthesia.

American Society of Regional Anesthesia and Pain Medicine
2018

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2018