Simulation provides excellent training and cost saving opportunities for invasive procedures such as central line placements.
April 14, 2015
It's well established in both the lay press and medical literature about how big of a risk medical errors are for patient safety. Every day there's preventable harm that occurs to patients in the medical environment due to communication and/or technology errors.
This is an area where simulation has a real opportunity to impact patient safety and improve the care that we deliver by reducing those preventable errors.
We're very excited about the results of our central line study performed here at Jump and done in collaboration with the University of Illinois College of Medicine at Peoria (UICOMP).
A central line placement is an invasive technical skill that is frequently performed in the hospital and has known complication rates.
Back when I trained in residency, we had the "see one, do one, teach one" model. I watched my senior resident perform one, then he watched me perform one.
At that time there wasn't the opportunity to practice on a manikin that would incur no harm to a patient. Now we have that opportunity.
These residents went through a rigorous simulation based protocol to learn how to perform a central line at the very top end of the scale of ability.
For about 18 months, we held monthly training sessions every month before the resident would rotate through the ICU. We collected data on their self-perception, confidence performing the procedure (both before and after), and what their experience was before doing the training.
They were mentored very carefully through a process where they used ultrasound and they were given direct feedback at every step as they learned this procedure.
We compared that to the 18 months previous to that, when there was no formal training program in place.
Not only did both groups show improvement in confidence, we have seen a definite financial impact, and a definite reduction in length of stay.
We've done an economic impact study with the Center for Outcomes Research UICOMP. The results seem to indicate that there has been over a million dollars worth of savings resulting from residents being able to perform at that top level.
The majority of the savings come from a reduction in length of stay, and from a reduction in the utilization of critical care resources inside our hospital.
If a patient has to be admitted to critical care because of their condition or because of a complication, the bills can really add up - we're talking about tens of thousands of dollars per day.
We also paid attention to how much money we used to train the residents, and it turns out there's a substantial return on this investment.
But the impact is really what the patient receives in terms of care on the far end of the study. Every resident we train may impact hundreds of patients during their time at the hospital.
John Vozenilek, MD, FACEP is the Vice President and Chief Medical Officer for Simulation at Jump. Dr. Vozenilek provides central coordination and oversight for OSF HealthCare undergraduate, graduate, interdisciplinary, and continuing medical education programs.