Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections

Barsuk, Jeffrey H.; Cohen, Elaine; Potts, Steven; Demo, Hany; Gupta, Shanu; Feinglass, Joe; McGaghie, William C.; Wayne, Diane B.

doi:10.1136/bmjqs-2013-002665

Cited by 162 publications

(147 citation statements)

References 38 publications

(40 reference statements)

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“…Fellows reported very high satisfaction with the SBML intervention, and their THDC skills improved dramatically at post-test. This is similar to the results of earlier studies (6,12,13,18,19,21) and consistent with others showing that SBML improves patient care outcomes and reduces associated health care costs (10)(11)(12)(13)(22)(23)(24)(25).…”

Section: Discussionsupporting

confidence: 92%

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

McQuillan

Clark

Zahirieh

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Concerns have been raised about nephrology fellows' skills in inserting temporary hemodialysis catheters. Less is known about temporary hemodialysis catheter insertion skills of attending nephrologists supervising these procedures. The aim of this study was to compare baseline temporary hemodialysis catheter insertion skills of attending nephrologists with the skills of nephrology fellows before and after a simulation-based mastery learning (SBML) intervention.Design, setting, participants, & measurements This pre-post-intervention study with a pretest-only comparison group was conducted at the University of Toronto in September of 2014. Participants were nephrology fellows and attending nephrologists from three university-affiliated academic hospitals who underwent baseline assessment of internal jugular temporary hemodialysis catheter insertion skills using a central venous catheter simulator. Fellows subsequently completed an SBML intervention, including deliberate practice with the central venous catheter simulator. Fellows were expected to meet or exceed a minimum passing score at post-test. Fellows who did not meet the minimum passing score completed additional deliberate practice. Attending nephrologist and fellow baseline performance on the temporary hemodialysis catheter skills assessment was compared. Fellows' pre-and post-test temporary hemodialysis catheter insertion performance was compared to assess the effectiveness of SBML. The skills assessment was scored using a previously published 28-item checklist. The minimum passing score was set at 79% of checklist items correct.Results In total, 19 attending nephrologists and 20 nephrology fellows participated in the study. Mean attending nephrologist checklist scores (46.1%; SD=29.5%) were similar to baseline scores of fellows (41.1% items correct; SD=21.4%; P=0.55). Only two of 19 attending nephrologists (11%) met the minimum passing score at baseline. After SBML, fellows' mean post-test score improved to 91.3% (SD=6.9%; P,0.001). Median time between pre-and post-test was 24 hours.Conclusions Attending nephrologists' baseline temporary hemodialysis catheter insertion skills were highly variable and similar to nephrology fellows' skills, with only a small minority able to competently insert a temporary hemodialysis catheter. SBML was extremely effective for training fellows and should be considered for attending nephrologists who supervise temporary hemodialysis catheter insertions.

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Section: Discussionsupporting

confidence: 92%

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

McQuillan

Clark

Zahirieh

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…Demographics, Experience, and Self-confidence of Participants (n = 49) (49) puncture, 40 and CVC insertion. [41][42][43] SBML is also a cost-effective intervention demonstrating a 7:1 return on investment from CLABSI reduction in 1 ICU. 44 The costs associated with our intervention included 2 to 3 hours of each nurse participant's time, the nurse educators' time, approximately $3000 in supplies, and simulators that were already owned by the hospital.…”

Section: Discussionmentioning

confidence: 99%

Simulation-Based Mastery Learning Improves Central Line Maintenance Skills of ICU Nurses

Barsuk

Cohen

Mikolajczak

et al. 2015

JONA: The Journal of Nursing Administration

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“…34 The SBML CVC curriculum dissemination also produced a 74% reduction in the incidence of CLABSI in the MHMC intensive care unit following the training, essentially replicating the NMH results. 34 MHMC infection control personnel and residents were not aware of the nature of the dissemination research study; MHMC infection control personnel were also not aware of the timing of the SBML CVC curriculum dissemination.…”

Section: • Rigorous Education Is a Key Component Of Clinical Qualitymentioning

confidence: 74%

Dissemination of an Innovative Mastery Learning Curriculum Grounded in Implementation Science Principles

et al. 2015

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Dissemination of a medical education innovation, such as mastery learning, from a setting where it has been used successfully to a new and different medical education environment is not easy. This article describes the uneven yet successful dissemination of a simulation-based mastery learning (SBML) curriculum on central venous catheter (CVC) insertion for internal medicine and emergency medicine residents across medical education settings. The dissemination program was grounded in implementation science principles. The article begins by describing implementation science which addresses the mechanisms of medical education and health care delivery. The authors then present a mastery learning case study in two phases: (1) the development, implementation, and evaluation of the SBML CVC curriculum at a tertiary care academic medical center; and (2) the dissemination of the SBML CVC curriculum to an academic community hospital setting. Contextual information about the drivers and barriers that affected the SBML CVC curriculum dissemination is presented. This work demonstrates that dissemination of mastery learning curricula, like all other medical education innovations, will fail without active educational leadership, personal contacts, dedication, hard work, rigorous measurement, and attention to implementation science principles. The article concludes by presenting a set of lessons learned about disseminating an SBML CVC curriculum across different medical education settings.

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Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections

Abstract: This study demonstrates successful dissemination and implementation of a CVC SBML curriculum and shows that rigorous medical education is a powerful quality improvement tool.

Cited by 162 publications

References 38 publications

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

Performance of Temporary Hemodialysis Catheter Insertion by Nephrology Fellows and Attending Nephrologists

Simulation-Based Mastery Learning Improves Central Line Maintenance Skills of ICU Nurses

Dissemination of an Innovative Mastery Learning Curriculum Grounded in Implementation Science Principles

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