title: Combining performance and outcome indicators can be used in a standardized way: a pilot study of two multidisciplinary, full-scale major aircraft exercises.
abstract: BACKGROUND
  Disaster medicine is a fairly young scientific discipline and there is a need for the development of new methods for evaluation and research. This includes full-scale disaster exercisers. A standardized concept on how to evaluate these exercises, could lead to easier identification of pitfalls caused by system-errors in the organization. The aim of this study was to demonstrate the feasibility of using a combination of performance and outcome indicators so that results can be compared in standardized full-scale exercises.
  
  
  METHODS
  Two multidisciplinary, full-scale exercises were studied in 2008 and 2010. The panorama had the same setup. Sets of performance indicators combined with indicators for unfavorable patient outcome were recorded in predesigned templates. Evaluators, all trained in a standardized way at a national disaster medicine centre, scored the results on predetermined locations; at the scene, at hospital and at the regional command and control.
  
  
  RESULTS
  All data regarding the performance indicators of the participants during the exercises were obtained as well as all data regarding indicators for patient outcome. Both exercises could therefore be compared regarding performance (processes) as well as outcome indicators. The data from the performance indicators during the exercises showed higher scores for the prehospital command in the second exercise 15 points and 3 points respectively. Results from the outcome indicators, patient survival and patient complications, demonstrated a higher number of preventable deaths and a lower number of preventable complications in the exercise 2010. In the exercise 2008 the number of preventable deaths was lower and the number of preventable complications was higher.
  
  
  CONCLUSIONS
  Standardized multidisciplinary, full-scale exercises in different settings can be conducted and evaluated with performance indicators combined with outcome indicators enabling results from exercises to be compared. If exercises are performed in a standardized way, results may serve as a basis for lessons learned. Future use of the same concept using the combination of performance indicators and patient outcome indicators may demonstrate new and important evidence that could lead to new and better knowledge that also may be applied during real incidents.
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education and Section of Emergency Medicine, Södersjukhuset, Stockholm, Sweden. monica.radestad@ki.se
authors.forename: Monica
authors.initials: M
authors.lastname: Rådestad
authors.forename: Heléne
authors.initials: H
authors.lastname: Nilsson
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
authors.forename: Leif
authors.initials: L
authors.lastname: Svensson
authors.forename: Anders
authors.initials: A
authors.lastname: Rüter
authors.forename: Dan
authors.initials: D
authors.lastname: Gryth
mesh_terms: D000401:Aircraft; D003659:Decision Making, Organizational; D054597:Disaster Medicine / Q000193:education*; D006801:Humans; D054527:Mass Casualty Incidents / Q000517:prevention & control*; D017145:Models, Educational; D016544:Patient Simulation; D010865:Pilot Projects; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies