Implementation of an Online External Ventricular Drain Training Module—An Educational Initiative to Improve Proficiency of Perioperative Health Care Providers: Results of a Retrospective Study

Abstract

Background: An external ventricular drain (EVD) training module may improve the knowledge and proficiency of perioperative health care providers (HCPs). Methods: We examined knowledge gaps, self-reported comfort in managing EVDs, and improvement in self-assessment scores among HCPs from 7 academic medical centers based on an online EVD training module. Results: Of the 326 HCPs who completed the module, 207 (70.6%) reported being uncomfortable managing EVDs. The median pretest scores were 6 (interquartile range=2), and posttest scores were 8 (interquartile range=1), out of a maximum possible score of 9. The most frequent incorrectly answered questions were: (a) maximum allowed hourly cerebrospinal fluid volume drainage (51%), (b) the components of a normal intracranial pressure waveform (41%), and (c) identifying the correct position of the stopcock for accurate measurement of intracranial pressure (41%). The overall gain in scores was 2 (interquartile range=2) and highest among HCPs who had managed 1 to 25 EVDs (2.51, 95% confidence interval: 2.23-2.80), and without self-reported comfort in managing EVDs (2.26, 95% confidence interval: 1.96-2.33, P<0.0001). The majority of participants (312, 95.7%) reported that the training module helped them understand how to manage EVDs, and 276 (84.7%) rated the module 8 or more out of 10 in recommending it to their colleagues. Conclusions: This online EVD training module was well-received by participants. Overall, improved scores reflect enhanced knowledge among HCPs following completion of the module. The greatest benefit was observed in those reporting less experience and feeling uncomfortable in managing EVDs. The impact on the reduction in EVD-associated adverse events deserves further examination.

Cerebrospinal fluid diversion devices and shunting procedures: a narrative review for the anesthesiologist

“…Those with infected VP shunts typically receive several days of antibiotics and a documented clearing of CSF infection before replacement of the CSF The preparation of patients is similar to that of EVD/LD or ETV, with a careful review and prompt reversal of any anticoagulant/anti-platelet agents and prompt administration of an antibiotic before the surgical incision. 63 and that knowledge gained is proportional to a lack of experience in managing EVDs. Peer support and support from a neurocritical care nurse or a neurosurgeon may be critical when providing anesthetic care to patients with CSF diversion devices.…”

“…Online (http://www.tinyurl.com/evdtraining) and in-person/simulation training may improve the proficiency of anesthesiologists who rarely encounter CSF diversion devices. Results of a multicenter study indicate that the use of online EVD educational modules may result in knowledge gained across multiple perioperative clinical disciplines 63 and that knowledge gained is proportional to a lack of experience in managing EVDs. Peer support and support from a neurocritical care nurse or a neurosurgeon may be critical when providing anesthetic care to patients with CSF diversion devices.…”