Simulation and Resource Stewardship: Preventing Further Distancing from Resident Education During a Socially Distanced Era (1090-004114) (Research Abstract Professor Rounds: Group 4)
Start time: Thursday, January 28, 2021, 1:00 PM End time: Thursday, January 28, 2021, 2:00 PM Session Type: Research Abstracts (Completed Studies)
Cost-effective decision making as a competency is not commonly incorporated into structured curriculum design deliverables in residency programs. The growing emphasis on patient harm from unnecessary medical interventions, coupled with commonly identified non-technical performance gaps among medical trainees such as information sharing, make evident the need to address the training gap on resource stewardship in medical education (Lass et al., 2015). The use of simulation to bridge this knowledge gap amongst Internal Medicine (IM) residents has been described in the works of Saleh, Campbell, and Altabbaa (2018). In the Coronavirus disease (COVID) era of social distancing, simulation can still be an effective modality for teaching residents resource stewardship to foster safer healthcare practices. Inappropriate prescribing of blood products, antibiotics, and telemetry can further compound the financial strain imposed by COVID on our healthcare system and lead to patient harm.
A cross-sectional study on cost-effective medical practices of 27 IM residents transitioning into the senior resident role participating in the program’s pre-established simulation curriculum was completed. The sessions included standardized case scenarios in addition to four separate telephone calls from resident or staff simulation educators that tested decision-making around selected Choosing Wisely Canada recommendations: avoidance of antibiotics in simple asthma exacerbations, blood product transfusion restrictions, and discouraging telemetry overuse. Data was collected by the resident or staff administering the phone call during the simulation session and was protected in a folder with password access. Participant identifiers were not collected. The indications and local costs of ordered tests and interventions were discussed during the facilitated reflection by simulation educators.
Twenty-seven IM residents transitioning into the senior resident role participated in simulation composed of multiple, and simultaneous stations deigned to replicate a busy night on call. Telemetry was unnecessarily ordered three out of six times (50%) during the simulation sessions, thereby incurring costs as high as $700 per patient stay. Unnecessary orders for platelets and blood units were observed in 16% (1/6 times) and 33% (2/6 times) of the cases, respectively. Antibiotics were correctly withheld 100% of the time (6/6).
Simulation is a cost-effective strategy for incorporating resource stewardship training into medical education and maintaining the delivery of medical curricula during social distancing. This quality improvement initiative is still in progress with the aim of expanding the data collection pool to include upcoming simulation sessions. Our anticipated hypothesis is that residents' overuse of telemetry and blood products will continue to be observed at an anticipated rate of 30%. The anticipated date of completion of this study is November 2020.