Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement

Tonya Jagneaux
Terrell S. Caffery, Emergency Medicine Residency Program-Baton Rouge Campus.
Mandi Wilkes Musso
Ann C. Long, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, Washington.
Lauren Zatarain, From the Internal Medicine Residency Program-Baton Rouge Campus, Louisiana State University Health Sciences Center School of Medicine in New Orleans.
Erik Stopa, Emergency Medicine Residency Program-Baton Rouge Campus.
Nathan Freeman, Emergency Medicine Residency Program-Baton Rouge Campus.
Cara Cantelli Quin


OBJECTIVE: We describe the effect of simulation-based education on residents' adherence to protocols for and performance of central venous access. METHODS: Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course. RESULTS: Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02). CONCLUSIONS: Simulation-based education significantly improved residents' knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.