Using Simulation and Competency Assessment to Decrease Inappropriate Referrals to a Comprehensive Vascular Access Team

Abstract

This department column highlights translation of research into health care quality practice. Achieving the highest quality of health care requires attention to creating and sustaining process efficiencies through the development of bedside provider competencies that result in workflow improvements and positive patient outcomes. An improvement intervention aimed at decreasing unnecessary referrals to a comprehensive vascular access team (CVAT) resulted in a 21% reduction in inappropriate consults to the team in approximately 6 weeks. The purpose of this article is to describe a simulation and competency assessment intervention aimed at increasing staff nurse proficiency in the emergency department for placing ultrasound-guided intravascular catheters, thereby reducing the number of inappropriate referrals to a CVAT team.

Educating health professionals in ultrasound guided peripheral intravenous cannulation: A systematic review of teaching methods, competence assessment, and patient outcomes

“…Of these studies, 8.6% (n = 3) were randomized controlled trials, [ 59 , 63 , 72 ] 22.9% (n = 8) were non-randomized interventional studies (pre/post studies), [ 41 , 42 , 53 , 54 , 56 , 57 , 64 , 66 ] 45.7% (n = 16) were longitudinal observational studies (of which 13 were prospective [ 10 , 40 , 43 – 45 , 47 – 49 , 55 , 58 , 62 , 69 , 71 ] and three were retrospective [ 51 , 67 , 68 ] ), 5.7% (n = 2) were cross-sectional observational studies [ 50 , 52 ] and 14.3% (n = 5) were quality improvement projects with methodology otherwise unspecified. [ 46 , 61 , 65 , 70 , 73 ] The vast majority of included studies described predominantly quantitative outcomes (97.1%, n = 34), with just one included study describing purely qualitative outcomes. [ 73 ]…”

“…[ 56 , 68 ] Some necessitated an attempt to be successful to count towards the quota for competency. [ 40 , 41 , 43 , 53 , 60 , 61 , 65 ]…”

“…Comparison to baseline data or pre-implementation audit data showed multiple improvements to patient and organizational outcomes among included studies. These included significantly reduced midline insertion rates, [ 41 ] central venous catheter insertion rates, [ 56 , 64 , 66 , 67 ] central venous catheter-associated bacteremia and sepsis, [ 66 ] self-reported difficulty of cannulation, [ 45 ] need for specialist vascular access team input, [ 57 , 58 , 61 ] therapy delays [ 65 ] and premature catheter failure rates. [ 66 ] They also described significantly improved procedural confidence, [ 10 , 40 , 42 , 54 , 63 ] knowledge [ 54 , 71 ] and competence, as evidenced by improved cannulation insertion attempts, success rate and first-time success.…”

“…Nguyen [61] (2020) Not specified Five successful, unassisted proctored attempts on patients Oliveira [62] (2016) DIVA: multiple unsuccessful attempts via traditional technique, known poor venous access or no visible or palpable veins Three proctored attempts on patients Osborn [63] (2012) Medical student peers Not discussed (Continued ) www.md-journal.com apheresis unit and achieved a success rate of 100% [56] and 14.3% of articles (n = 5) did not specify.…”

“…No significant increase in success rates or minimum passing standard (MPS) scoring with increasing numbers of simulation attempts. On unplanned follow-up 6 mo later (65% retention), MPS performance was lowest in those who had 0 additional simulation attempts Moore [60] (2013) Not specified 94.0% 81.0% Reduction from 44% to 34% in placement of ultrasound guided PIVCs in the antecubital fossa over the year Nguyen [61] (2020)…”