• Louise Hull, David Birnbach, Sonal Arora, Maureen Fitzpatrick, and Nick Sevdalis.
• *Department of Surgery and Cancer, Imperial College London, UK; and †Department of Anesthesiology, UM-JMH Center for Patient Safety, Miller School of Medicine, University of Miami, FL.
• Ann. Surg.. 2014 May 1;259(5):904-9.

ObjectiveTo develop a toolkit that covers the clinical, nontechnical, and empathic skills required for effective, safe surgical ward care.BackgroundDespite the explosion of interest in patient safety, little attention has been placed on the skill set required for safe and effective surgical ward care. Currently, there is a lack of a systematic approach to improving ward care via assessing and improving residents' ward care skills.MethodsA comprehensive evidence-based and expert-derived toolkit was developed, including a novel clinical checklist for ward care (Clinical Skills Assessment for Ward Care: C-SAW-C); a novel team assessment scale for wards rounds (Teamwork Skills Assessment for Ward Care: T-SAW-C); and a revised version of a physician-patient interaction scale (Physician-Patient Interaction Global Rating Scale: PP-GIS). Interassessor reliability (κ, intraclass correlation), internal consistency (Cronbach α), and convergent validity (Pearson r correlations) were evaluated statistically in 38 simulated scenarios (during which a patient rapidly deteriorated) involving 185 residents.ResultsExcellent interassessor reliability was obtained for C-SAW-C [median κ = 0.89; median intraclass correlation coefficient (ICC) = 0.94], T-SAW-C (median ICC = 0.99), and the revised PP-GIs (κ = 1.00; ICC = 0.98 or higher). Internal consistency was also very high for all team skills assessed by T-SAW-C (Cronbach α range 0.87-0.94 across 6 skills) and the revised PP-GIS (Cronbach α = 0.96)-all P's < 0.001. Significant positive correlations were obtained between the 3 assessments (r = 0.73-0.92, P < 0.001) thus showing evidence for convergent validity.ConclusionsWe developed a toolkit that captures comprehensively the skills that are required for safe and effective ward care, including the high-risk situation where a patient decompensates. The toolkit offers a systematic evaluation of the quality and safety of surgical ward care and can be used to train and debrief residents' skills and performance.

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