Development of a Safety-focused High-Fidelity Simulation Training Course for Real-time Ultrasonography-guided Central Venous Catheterization: An Evidence-based Skill Training Course according to the “Do No Harm” Principle (1090-003636) (Research Abstract Oral: Procedure)
Start time: Monday, January 25, 2021, 8:00 AM End time: Monday, January 25, 2021, 9:00 AM Session Type: Research Abstracts (Completed Studies)
In 2017, the Japan Medical Safety Research Organization issued special warnings about the serious complications of central venous catheterization (CVC) and reported 12 fatal cases. Among 10 analyzed cases, complications occurred during ultrasonography (US)-guided procedures in six cases. For knowledge translation to clinical practice, a simulation-based skill training course was recommended to understand the standard procedure and its pitfalls. The CVC committee of our university hospital was established to develop a comprehensive CVC safety system of the hospital. We revised our practice guidelines as a CVC manual according to the patient-safety principle. Finally, we designed and developed a simulation system in accordance with the evidence-based procedure with a strict protocol, which conformed to the Japanese Society of Medical Simulation (JAMS) CVC course. The results of the performance assessments for the attendees were analyzed to optimize the safety-focused simulation training.
The course was designed as a high-fidelity hands-on course using ultrasonic equipment and simulators to acquire the skill for performing the internal jugular vein puncture technique under real-time ultrasonic guidance. For the cognitive domain of competence, a blackboard learning management system was used, and a computer-based test was conducted during the skill training. In the 150-min training session, after a 30-minute lecture, a 100-minute practice session was conducted, which included a skill test and catheter insertion procedure. The simulator, CVC Puncture Insertion Simulator (Kyoto Kagaku), and Venue 50 Ultrasound (GE Healthcare Japan) were prepared by one of three students. Understanding the pitfalls of real-time ultrasonic guidance was emphasized. Procedures such as pre-scanning, out-of-plane use of US, real-time ultrasonic guidance, and confirmation of the needle and inserted guidewire were decided and used as core skills in the skill assessment checklist.
Data from 182 experienced doctors (ExD) and 31 junior residents (JR) among the 256 attendees for 2 years were analyzed. Of the ExD, 66% had an experience of =30 US-guided CVC cases as an expert and 182 had successfully passed the instructor assessment involving direct observation of procedural skills and a final oral examination. Among the ExD, 166 (91.2%) were ranked grade A (excellent) or B (good) and 16 (8.8%) were ranked grade C (fair). Among the 31 JR, 25 (81%) were ranked grade C, and 6 (19%) needed additional training and skill tests to pass. The questionnaire results, rated using a 4-point scale, showed that 99% of the 207 attendees agreed that the simulation was effective in terms of patient safety. No significant difference was found between the ExD and JR groups. Of the 177 ExD and 23 JR, 170 (96.0%) and 30 (76.6%) agreed, respectively, that US guidance provides confidence in CVC insertion. A chi-squared test revealed a significant difference between the two groups (p<0.01).
By referring to the latest evidence and the contents of the JAMS CVC seminars, a high-fidelity task training course was designed and implemented. As the ExD achieved excellent outcomes and achieved great satisfaction from their acquired hands-on skills, this compact and focused program was considered satisfactory, suitable for the needs of the participants, and effective for CVC implementation. The JR group were less competent and less satisfied with their self-confidence, but they performed relatively well as beginners. From their self-estimation of their knowledge of the patient-safety concept, which showed no significant difference from that of ExD, we hope that they fully understand the concept of zero-risk intervention and share the mindset of experts. Based on the results of learner assessment and course evaluation, the quality of the CVC safety program can be improved and the simulation skill training sessions can be redesigned for both experts and less experienced doctors.