Using checklists and algorithms to improve qualitative exposure judgment accuracy.

Most exposure assessments are conducted without the aid of robust personal exposure data and are based instead on qualitative inputs such as education and experience, training, documentation on the process chemicals, tasks and equipment, and other information. Qualitative assessments determine whether there is any follow-up, and influence the type that occurs, such as quantitative sampling, worker training, and implementing exposure and risk management measures. Accurate qualitative exposure judgments ensure appropriate follow-up that in turn ensures appropriate exposure management. Studies suggest that qualitative judgment accuracy is low. A qualitative exposure assessment Checklist tool was developed to guide the application of a set of heuristics to aid decision making. Practicing hygienists (n = 39) and novice industrial hygienists (n = 8) were recruited for a study evaluating the influence of the Checklist on exposure judgment accuracy. Participants generated 85 pre-training judgments and 195 Checklist-guided judgments. Pre-training judgment accuracy was low (33%) and not statistically significantly different from random chance. A tendency for IHs to underestimate the true exposure was observed. Exposure judgment accuracy improved significantly (p <0.001) to 63% when aided by the Checklist. Qualitative judgments guided by the Checklist tool were categorically accurate or over-estimated the true exposure by one category 70% of the time. The overall magnitude of exposure judgment precision also improved following training. Fleiss' κ, evaluating inter-rater agreement between novice assessors was fair to moderate (κ = 0.39). Cohen's weighted and unweighted κ were good to excellent for novice (0.77 and 0.80) and practicing IHs (0.73 and 0.89), respectively. Checklist judgment accuracy was similar to quantitative exposure judgment accuracy observed in studies of similar design using personal exposure measurements, suggesting that the tool could be useful in developing informed priors and further demonstrating its usefulness in producing accurate qualitative exposure judgments.