Central line-associated bloodstream infections (CLABSIs) are preventable complications that pose a significant health risk to patients and place a financial burden on hospitals. Central line simulation-based education (SBE) efforts vary widely in the literature. The aim of this study was to perform a value analysis of published central line SBE and develop a refined method of studying central line SBE.
Methods
A database search of PubMed Central and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for articles mentioning “Cost and CLABSI,” “Cost and Central line Associated Bloodstream Infections,” and “Cost and Central Line” in their abstract and article body. Articles chosen for qualitative synthesis mentioned “simulation” in their abstract and article body and were analyzed based on the following criteria: infection rate before vs. after SBE, cost of simulation, SBE design including simulator model used, and learner analysis.
Results
Of 215 articles identified, 23 were analyzed, 10 (43.48%) discussed cost of central line simulation with varying criteria for cost reporting, 8 (34.8%) numerically discussed central line complication rates (7 CLABSIs and 1 pneumothorax), and only 3 (13%) discussed both (Figure). Only 1 addressed the true cost of simulation (including space rental, equipment startup costs, and faculty salary) and its longitudinal effect on CLABSIs.
Conclusion
Current literature on central line SBE efforts lacks value propositions. Due to the lack of value-based data in the area of central line SBE, the authors propose a cost reporting standard for use by future studies reporting central line SBE costs.
WiseMEScottRDBaggsJM, et al.National estimates of central line–associated bloodstream infections in critical care patients. Infect Contr Hosp Epidemiol. 2013;34(6):547-554. doi:10.1086/670629
2.
ZieglerMJPellegriniDCSafdarN. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection. 2014;43(1):29-36. doi:10.1007/s15010-014-0689-y
3.
Centers for Disease Control and Prevention (CDC). Unhealthy sleep-related behaviors--12 States, 2009. MMWR Morbidity and mortality weekly report. 2011;60(8):233-238. Accessed October 2, 2020. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm
4.
BarsukJHCohenERFeinglassJMcGaghieWCWayneDB. Use of simulation-based education to reduce catheter-related bloodstream infections. Arch Intern Med. 2009;169(15):1420-1423. doi:10.1001/archinternmed.2009.215
5.
AhyaSNBarsukJHCohenERTuazonJMcGaghieWCWayneDB. Clinical performance and skill retention after simulation-based education for nephrology fellows. Semin Dial. 2012;25(4):470-473. doi:10.1111/j.1525-139X.2011.01018.x
6.
BadashIBurttKSolorzanoCACareyJN. Innovations in surgery simulation: A review of past, current and future techniques. Ann Transl Med. 2016;4(23):453. doi:10.21037/atm.2016.12.24
7.
PorterME. What is value in health care?N Engl J Med. 2010;363(26):2477-2481. doi:10.1056/nejmp1011024
8.
BrownMBrownGSharmaS. Evidence-Based Medicine to Value Based Medicine. IL, USA: AMA Press; 2005.
9.
FletcherJDWindAP. Cost considerations in using simulations for medical training. Mil Med. 2013;178:37. doi:10.7205/MILMED-D-13-00258
10.
BarsukJHMcGaghieWCCohenERBalachandranJSWayneDB. Use of simulation-based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit. J Hosp Med. 2009;4(7):397-403. doi:10.1002/jhm.468
11.
MacnabAJMacnabM. Teaching pediatric procedures: the Vancouver model for instructing Seldinger’s technique of central venous access via the femoral vein. Pediatrics. 1999;103(1):E8. doi:10.1542/peds.103.1.e8
12.
BarsukJHCohenERPottsS, et al.Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Qual Saf. 2014;23(9):749-756. doi:10.1136/bmjqs-2013-002665
13.
SekiguchiHTokitaJEMinamiTEisenLAMayoPHNarasimhanM. A prerotational, simulation-based workshop improves the safety of central venous catheter insertion: Results of a successful internal medicine house staff training program. Chest. 2011;140(3):652-658. doi:10.1378/chest.10-3319
14.
PepleyDFGordonABYovanoffMA, et al.Training surgical residents with a haptic robotic central venous catheterization simulator. J Surg Educ. 2017;74(6):1066-1073. doi:10.1016/j.jsurg.2017.06.003
15.
HauglumSDCrenshawNAGattamortaKAMitzova-VladinovG. Evaluation of a low-cost, high-fidelity animal model to train graduate advanced practice nursing students in the performance of ultrasound-guided central line catheter insertion. Simulat Healthc J Soc Med Simulat. 2018;13(5):341-347. doi:10.1097/SIH.0000000000000337
16.
MartinMScalabriniBRiouxAXhignesseMA. Training fourth-year medical students in critical invasive skills improves subsequent patient safety. Am Surg. 2003;69(5):437-440.
17.
SherertzRJElyEWWestbrookDM, et al.Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med. 2000;132(8):641-648. doi:10.7326/0003-4819-132-8-200004180-00007
18.
MillingtonSJWongRYKassenBORobertsJMMaIWY. Improving internal medicine residents’ performance, knowledge, and confidence in central venous catheterization using simulators. J Hosp Med. 2009;4(7):410-416. doi:10.1002/jhm.570
19.
LengettiEMonachinoAMScholtzA. A simulation-based “just in time” and “just in place” central venous catheter education program. J Nurses Staff Dev. 2011;27(6):290-293. doi:10.1097/NND.0b013e318237117c
20.
LenhardAMoallemMMarrieRABeckerJGarlandA. An intervention to improve procedure education for internal medicine residents. J Gen Intern Med. 2008;23(3):288-293. doi:10.1007/s11606-008-0513-4
21.
CohenERFeinglassJBarsukJH, et al.Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit. Society for Simulation in Healthcare. 2010;5(2):98-102. doi:10.1097/SIH.0b013e3181bc8304
22.
BrittRCNovoselTJBrittLDSullivanM. The impact of central line simulation before the ICU experience. Am J Surg. 2009;197(4):533-536. doi:10.1016/j.amjsurg.2008.11.016
23.
OermannMHKrusmarkMAKardong-EdgrenSJastrzembskiTSGluckKA. Training interval in cardiopulmonary resuscitation. PloS One. 2020;15(1):e0226786. doi:10.1371/journal.pone.0226786
24.
IssenbergSBMcGaghieWCPetrusaERGordonDLScaleseRJ. Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Med Teach. 2005;27(1):10-28. doi:10.1080/01421590500046924
BarsukJHCohenERMcGaghieWCWayneDB. Long-term retention of central venous catheter insertion skills after simulation-based mastery learning. Acad Med. 2010;85(10 suppl L):S9. doi:10.1097/ACM.0b013e3181ed436c
27.
LaackTADongYGoyalDGSadostyATSuriHSDunnWF. Short-term and long-term impact of the central line workshop on resident clinical performance during simulated central line placement. Simulat Healthc J Soc Med Simulat. 2014;9(4):228-233. doi:10.1097/SIH.0000000000000015
28.
SofflerMIHayesMMSmithCC. Central venous catheterization training: current perspectives on the role of simulation. Adv Med Educ Pract. 2018;9:395-403. doi:10.2147/amep.s142605
29.
MaIWYBrindleMERonksleyPELorenzettiDLSauveRSGhaliWA. Use of simulation-based education to improve outcomes of central venous catheterization: a systematic review and meta-analysis. Acad Med. 2011;86(9):1137-1147. doi:10.1097/ACM.0b013e318226a204
30.
CookDAAndersenDKCombesJRFeldmanDLSachdevaAK. The value proposition of simulation-based education. Surgery (United States). 2018;163(4):944-949. doi:10.1016/j.surg.2017.11.008
31.
Agency for Health Research and Quality. Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. Published 2019. Accessed October 2, 2020. https://www.ahrq.gov/hai/pfp/haccost2017-results.html
32.
BarsukJHMcGaghieWCCohenERO’LearyKJWayneDB. Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit*. Crit Care Med. 2009;37(10):2697-2701. doi:10.1097/CCM.0b013e3181a57bc1
33.
MirandaJATrickWEEvansATCharles-DamteMReillyBMClarkeP. Firm-based trial to improve central venous catheter insertion practices. J Hosp Med. 2007;2(3):135-142. doi:10.1002/jhm.168
34.
BrittRCReedSFBrittLD. Central line simulation: A new training algorithm. Am Surg. 2007;73(7):680-682. doi:10.1177/000313480707300708
35.
VelmahosGCToutouzasKGSillinLF, et al.Cognitive task analysis for teaching technical skills in an inanimate surgical skills laboratory. Am J Surg. 2004;187(1):114-119. doi:10.1016/j.amjsurg.2002.12.005
36.
Christopher SmithCHuangGCNewmanLR, et al.Simulation training and its effect on long-term resident performance in central venous catheterization. Simulat Healthc J Soc Med Simulat. 2010;5(3):146-151. doi:10.1097/SIH.0b013e3181dd9672
37.
BrownRFTignanelliCGrudziakJ, et al.A comparison of a homemade central line simulator to commercial models. J Surg Res. 2017;214:203-208. doi:10.1016/j.jss.2017.02.071
38.
RosenBTUddinPQHarringtonARAultBWAultMJ. Does personalized vascular access training on a nonhuman tissue model allow for learning and retention of central line placement skills? Phase II of the procedural patient safety initiative (PPSI-II). J Hosp Med. 2009;4(7):423-429. doi:10.1002/jhm.571
39.
AultMJRosenBTAultB. The use of tissue models for vascular access training: phase I of the procedural patient safety initiative. J Gen Intern Med. 2006;21(5):514-517. doi:10.1111/j.1525-1497.2006.00440.x
40.
LiachopoulouAPSynodinou-KamilouEEDeligiannidiPGGiannakopoulouMBirbasKN. Nurses’ training and confidence on deep venous catheterization. Technol Health Care. 2008;16(3):159-169. doi:10.3233/thc-2008-16302
