Central Venous Catheter Insertion Train the Trainer

Study Overview
=================
Brief Summary
-----------------
The investigators previously successfully implemented a central venous catheter (CVC) simulation-based mastery learning (SBML) curriculum at Northwestern University. As a result, trainee skill improved, complications, including central line associated bloodstream infections (CLABSIs) decreased and the curriculum was proven cost-effective. Therefore the Veterans Administration Medical Centers (VAMC) decided to implement this training at some of their sites as a quality improvement project. The investigators will train faculty at these locations to implement the same curriculum at their individual sites. Outcome data will be collected to evaluate the outcomes of the quality improvement (QI) project (complications, infections, skills).

Detailed Description
-----------------
Beginning in 2006, Northwestern University Internal Medicine and Emergency Medicine residents completed simulation-based mastery learning in central venous catheter (CVC) insertion before clinical rotations in the Medical Intensive Care Unit (MICU). This comprehensive program in central line training used repetitive practice and simulation technology to train residents to mastery standards. This study had important patient safety implications. This program resulted in improved trainee skill and reduced CVC insertion complications, including a significant decrease in the rate of central line associated bloodstream infections (CLABSI). In addition, the investigators showed that the in CVC insertion was highly cost-effective suggesting that investment in simulation training can produce significant medical care cost savings. This curriculum has now been successfully implemented at a few other sites. Due to the investigators' success, the VA has requested that Medical Error Reduction and Certification, Inc.(MERCI) along with Northwestern University, implements the curriculum at its sites across the county as a quality improvement project. Using a train the trainer course in CVC placement, the investigators are interested in analyzing the data that the VAMC will provide to MERCI and studying the outcomes. Four Northwestern faculty completed a CVC insertion Master trainer curriculum. One master trainer travels to each VA facility in the program to facilitate a two-day train-the-trainer course on CVC insertion SBML. Each VA facility selects one or two faculty champions who complete CVC insertion SBML course and learn how to teach the curriculum on day 1 and are observed training and assessing peer healthcare providers at their institution on day 2. Course materials include standardized videos and lectures, role-playing and practice with sample learners and CVC insertion assessments. In addition to the onsite master trainer, each VA facility receives necessary training materials (standardized video lectures, data collection forms, assessment tools) and equipment (CentralLineMan simulators, ultrasound) to implement the curriculum at their institution. All participants complete pre and post testing and a course evaluation questionnaire. Quantitative outcome data on learner skills and CVC insertion quality measures are collected to measure the overall success of the project.

Official Title
-----------------
Dissemination of a Simulation-based Mastery Learning Curriculum for Central Venous Catheter Insertion at Veterans Affairs Hospitals: A Quantitative Study

Conditions
-----------------
Healthy

Intervention / Treatment
-----------------
* Behavioral: CVC Train the Trainer


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Previously (or prospectively) collected de-identified data on trainee skill and experience Previously (or prospectively) collected de-identified data on patients in the VA ICU with CVCs Previously (or prospectively) collected de-identified data on mechanical complications in the ICUs Exclusion Criteria: Data not de-identified Data on pts on non-ICU units Data on pts without CVCs

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Traditionally-trained<br>Patients who undergo CVC procedures by traditionally-trained providers who have not undergone simulation-based mastery learning. This could be retrospective (before the study started) or at a site where the training was not implemented. | |
| CVC Train the Trainer<br>Patients who undergo CVC procedures by providers who have participated in simulation-based mastery learning. | Behavioral: CVC Train the Trainer<br>* Trainees receive a simulation-based mastery learning intervention and train-the-trainer program on central venous catheter insertion<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The effectiveness of simulation based mastery learning for CVC insertion on CLABSIs | Data from infection control on central line associated bloodstream infections will be reported for all sites each month. The investigators plan to compare the trained ICU's infection rates with other ICUs at other sites in addition to comparing the trained period versus the untrained period while trainees were rotating through the MICU. | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The effectiveness of simulation based mastery learning for CVC insertion on mechanical complications | ICUs will collect information on actual CVC insertions including complications (need for line adjustment, arterial puncture, pneumothorax). The investigators plan to compare the trained ICU's complication rates with other ICUs at other sites in addition to comparing the trained period versus the untrained period while trainees were rotating through the MICU. | 3 years | 
| The effectiveness simulation based mastery learning for CVC insertion at the learner level using simulated checklist data and trainee surveys | Using simulated checklist data and trainee surveys, the investigators will assess the effectiveness of our intervention at the learner level. | 2 years | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Central Venous Catheter, Simulation-based Mastery Learning, Medical Education, Patient Outcomes, Bloodstream Infection Due to Central Venous Catheter, Pneumothorax, Inadvertent Arterial Puncture