533 - Moving Procedural Training to the Bedside Environment: Just-in-Place, Interprofessional, Simulation-based Central Venous Access Training in a Pediatric Emergency Department

Poster Number: 533
Publication Number: 533.228

Rachel Bensman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Michael T. Stratton, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Katherine J. Edmunds, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kelly Krummen, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Theresa Frey, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Gary L. Geis, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Anne Runkle, Ohio State University College of Medicine, Columbus, OH, United States

Background: Central venous catheter (CVC) placements are high-risk, low frequency events in the Pediatric Emergency Department (PED). There is a need to improve training methods to acquire and maintain skills for such infrequent but critical procedures.

Objective: The objective of this project was to develop and assess a novel just-in-place, interprofessional, simulation-based CVC training program for PED physician-nurse teams.

Design/Methods: This was a prospective educational intervention for PED physicians and nurses. The training focused on (a) selection of equipment, (b) organization of equipment and procedural setup, (c) use of point-of-care ultrasound, (d) procedural performance, and (e) guidewire safety in the actual patient care environment – Just-in-Place. The training used a 2-person team approach to CVC placement: proceduralist (physician) and supervisor (nurse) used the institutional CVC Insertion Checklist (Figure 1) to obtain supplies, insert an ultrasound-guided CVC on a manikin under sterile technique, and document safety checks. Trained facilitators provided iterative feedback and teaching.
The educational intervention was evaluated with a pre- and post-training survey at the individual level, and an observed behavior checklist at the team level. The survey assessed Kirkpatrick level 1 and 2 outcomes, including knowledge of the equipment and procedure and perceived barriers to CVC placement. Pre-post surveys were compared using Wilcoxon signed rank test for attitudes and McNemar’s test for knowledge assessment.

Results: 44 physicians and 25 nurses completed the training. When high clinical volume prevented nurse participation at certain sessions, a facilitator filled the nurse role. Pre-post surveys of physicians showed improvements in comfort with decision-making, equipment procurement and assembly, ultrasound use, procedural performance, and assurance of safety and sterility (Figure 2), and improved knowledge of ultrasound usage, image interpretation, patient positioning, and required safety checks (p-values < 0.01). Direct observation of training revealed highest frequencies of errors around finding and preparing equipment and ultrasound skills. Following this project, we created a trauma bay CVC cart with equipment and cognitive aids to target barriers to CVC insertion that we had identified.

Conclusion(s): Just-in-place, simulation-based training increases physician and nurse knowledge and comfort with placement of a CVC by training together in the actual patient care environment. This may translate to improved procedural performance and safety, of infrequent, but critical PED procedures.