Simulation: Improving Outcomes for Patients?

As discussed in my last post, outcomes for training programs can be stratified into four different levels based on the Kirkpatrick Model. I started to search for papers that demonstrated an impact on patient outcomes (Level 4 in the Kirkpatrick Model), and with some guidance from Dr. Cavalcanti, I was able to find a couple.

Use of Simulation-Based Education to Reduce Catheter- Related Bloodstream Infections- Barsuk et al. 2009

In my last post I mentioned a study by Barsuk et al. from 2009 that demonstrated a change in rates of catheter related bloodstream infections after a simulation-based curriculum in central line insertion was instituted. The study compared rates of catheter related bloodstream infections before and after a simulation program was put in place. The program itself consisted of a pre-test, five-hour session with a videotaped lecture and three-hour training session with an ultrasound machine and practice on a simulator, followed by a post-test that the trainees were required to pass. The rates of infection before the simulation program was started were 3.2 per 1000 catheter days in the medical ICU and 4.86 infections in the surgical ICU. After the simulation-training program was instituted the rate of infections in the medical ICU dropped to 0.5 per 100 catheter days, but remained at 5.26 per 1000 catheter days in the surgical ICU.

Performance of Medical Residents in Sterile Techniques During Central Vein Catheterization- Khouli et al. 2011

This was a similar paper to the Barsuk one, however in this study the resident participants were randomized to receive simulation based training and video training or video training alone. The study also examined rates of catheter related bloodstream infections in ICU patients as well as the trainee’s sterile technique. The study found that rates of infections decreased in the medical ICU from 3.4 infections per 1000 catheter days to 1.0 infection per 1000 catheter days.  However in the surgical ICU the rates of infections remained unchanged at 3.4 infections per 1000 catheter days (again in the surgical ICU). Sterile technique improved in the intervention group as well.

These results showed that the simulation training not only had benefit in terms of the behaviors of the trainees (Level 3 in the Kirkpatrick Model) but also in patient outcomes (Level 4).

Like I've mentioned before, I have always found the simulation training we got to participate in during medical school incredibly valuable.  We have had experience with various simulated cardiac and airway emergencies during our anesthesia rotation, airway emergencies and anaphylaxis during our emergency medicine rotation, and heart sounds during our medicine rotation. The scenarios would respond realistically to our treatment decisions, and it was the first time I felt like we the students were the ones in charge and that our decisions held weight. For example, during our anesthesia rotation, we were able to run an ACLS algorithm and watch as the bedside monitor reflected the patient's condition. The advanced technology helped make the sessions feel more “real” and definitely helped nudge my confidence in my ability to handle these situations up from “none” to “a little”. It’s definitely something I’d look forward to in my residency training.

These opinions and thoughts are on an individual level though, and so that is why it was interesting to read a couple of studies that showed the positive impact that simulation training had on higher “population level” patient outcomes in the ICU.  

-SR