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1.
J Infus Nurs ; 42(2): 249-253, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31464833

RESUMEN

Every health care facility aims to achieve and maintain a zero central line-associated bloodstream infection (CLABSI) rate. Infections can be costly for institutions of any size and are often not covered by health insurance. The interventions put in place in this quality improvement project were implemented in 4 phases: (1) develop a new standard of care for central lines and give nurses full responsibility for the care and handling of these lines (including blood sampling); (2) revise policy and provide educational sessions to support nurses; (3) document compliance with the new policy; and (4) document CLABSI rates. The project took place during a 15-month period between January 1, 2016 and March 30, 2017, in 4 critical care units in a university medical center in Lebanon. The results revealed a reduction in CLABSI rates from a maximum rate of more than 17 per 1000 catheter days to zero per 1000 catheter days, which was sustained for 10 months. Nurse compliance with the new policy after 3 months ranged from 95% to 99%.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/normas , Enfermería de Cuidados Críticos/educación , Adhesión a Directriz/normas , Control de Infecciones/normas , Unidades de Cuidados Intensivos , Centros Médicos Académicos , Adulto , Adhesión a Directriz/estadística & datos numéricos , Humanos , Líbano , Mejoramiento de la Calidad
2.
J Infus Nurs ; 42(4): 193-196, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31283661

RESUMEN

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Control de Infecciones/métodos , Grupo de Atención al Paciente/normas , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/métodos , Adhesión a Directriz , Humanos , Estudios Retrospectivos
3.
J Infus Nurs ; 42(3): 137-142, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30985562

RESUMEN

Central line-associated bloodstream infection (CLABSI) can result in increased length of hospital stay and increased costs for both patients and organizations. This article illustrates how a multidisciplinary collaboration and the use of scientific evaluation and implementation tools can facilitate a decrease in CLABSIs and have a positive effect on staff satisfaction when caring for central lines.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central , Catéteres Venosos Centrales , Práctica Clínica Basada en la Evidencia , Unidades de Cuidado Intensivo Pediátrico , Grupo de Atención al Paciente/normas , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Cateterismo Venoso Central/estadística & datos numéricos , Niño , Infección Hospitalaria/prevención & control , Humanos , Control de Infecciones/métodos , Dispositivos de Acceso Vascular
4.
Br J Nurs ; 28(8): S4-S12, 2019 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-31002548

RESUMEN

This article reports on the findings of a repeat audit of vascular access devices (VADs) in a district general hospital undertaken 4 years after a previous audit. The first demonstrated poor standards of care and low compliance with evidence-based guidelines, indicating that a change in practice was necessary. A strategy of training, education and standardisation for intravenous devices was introduced, with the goal of transforming practice to raise standards and improve compliance. The findings of the follow-up audit show that the strategy has been successful in raising standards of care and reducing infections.


Asunto(s)
Cateterismo Venoso Central/normas , Dispositivos de Acceso Vascular , Infecciones Relacionadas con Catéteres/prevención & control , Práctica Clínica Basada en la Evidencia , Estudios de Seguimiento , Adhesión a Directriz/estadística & datos numéricos , Hospitales de Distrito , Hospitales Generales , Humanos , Auditoría Médica , Guías de Práctica Clínica como Asunto , Reino Unido
5.
Mil Med ; 184(Suppl 1): 329-334, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30901427

RESUMEN

In a study with 76 anesthesia providers on a mixed reality simulator, central venous access via the supraclavicular approach to the subclavian vein, without ultrasonography required less attempts compared to the infraclavicular approach. Participants had shorter times to venous access and larger improvements in confidence. Results from this simulation-based study indicate that the supraclavicular approach may deserve consideration as an alternative approach for central venous access in deployed military environments. The use of ultrasonography during the supraclavicular approach to the subclavian vein is also described which may improve its safety profile. This technique could be more appropriate in scenarios when central venous access is preferred over intraosseous access for patients being transported to another location for further care.


Asunto(s)
Cateterismo Venoso Central/métodos , Simulación de Paciente , Cateterismo Venoso Central/normas , Florida , Humanos , Medicina Militar/educación , Seguridad del Paciente/normas , Vena Subclavia/anatomía & histología , Ultrasonografía Intervencional/métodos
6.
Blood Purif ; 48(1): 1-9, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30763936

RESUMEN

BACKGROUND: Central venous catheter (CVC) is commonly used to provide access for hemodialysis (HD) when arteriovenous access is not available. The misplacement of CVC into azygos vein (AV) is a rare but a potential serious complication. Previous reports communicated the opinion that left-sided catheterization predisposed to AV misplacement, but these reports concentrated on peripherally inserted CVCs, placed for indications rather than HD. Unintended AV misplacement of HD catheters (HDCs) has not been well studied. We seek to investigate factors associated with inadvertent AV miscannulation during HDC placement. METHODS: We are to present a case of unintentional misplacement of a tunneled HD catheter (tHDC) into the azygos arch from right internal jugular vein (RIJV) despite real-time fluoroscopy guidance. Additionally, we have undertaken a systematic literature search in Pubmed to study the anatomical and other factors related to unintended AV misposition in HD setting. RESULTS: From 2005 to August 31, 2018, a total of 11 articles containing 16 cases of misplacement of HDCs into AV were identified. Of the 17 cases of unintentional AV misposition including ours, the majority of the misguided HDCs (94.1%, 16/17) were tHDCs and only 1 case was related to a temporary (non-tunneled) catheter. Most catheter misplacements (88.2%, 15/17) were performed without real-time radiological guidance. The reported incidence of inadvertent AV cannulation from different institutions varied between 0.6% and 3.8%. Among the 16 misplaced tHDCs, the rates of AV misposition that arose from RIJV and left internal jugular vein (LIJV) insertion are even at 50%. CONCLUSIONS: Based upon anatomical and case studies, we have found that AV may join posterior aspect of superior vena cava at different directions and levels. Hence, this might explain why AV misplacement might occur whether an HDC is inserted from the LIJV or RIJV approach. By raising the awareness of this potential complication and how we may minimize it, we hope to reduce the future complication of AV misposition.


Asunto(s)
Vena Ácigos , Cateterismo Venoso Central , Catéteres Venosos Centrales , Errores Médicos , Diálisis Renal , Anciano , Vena Ácigos/cirugía , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Catéteres Venosos Centrales/normas , Humanos , Venas Yugulares/cirugía , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Masculino , Radiografía Torácica , Diálisis Renal/normas
7.
Simul Healthc ; 14(1): 35-42, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30601466

RESUMEN

INTRODUCTION: High-tech simulators are gaining popularity in surgical training programs because of their potential for improving clinical outcomes. However, most simulators are static in nature and only represent a single anatomical patient configuration. The Dynamic Haptic Robotic Training (DHRT) system was developed to simulate these diverse patient anatomies during Central Venous Catheterization (CVC) training. This article explores the use of the DHRT system to evaluate objective metrics for CVC insertion by comparing the performance of experts and novices. METHODS: Eleven expert surgeons and 13 first-year surgical residents (novices) performed multiple needle insertion trials on the DHRT system. Differences between expert and novice performance on the following five metrics were assessed using a multivariate analysis of variance: path length, standard deviation of deviations (SDoD), average velocity, distance to the center of the vessel, and time to complete (TtC) the needle insertion. A regression analysis was performed to identify if expertise could be predicted using these metrics. Then, a curve fit was conducted to identify whether learning curves were present for experts or novices on any of these five metrics. RESULTS: Time to complete the insertion and SDoD of the needle tip from an ideal path were significantly different between experts and novices. Learning curves were not present for experts but indicated a significant decrease in path length and TtC for novices. CONCLUSIONS: The DHRT system was able to identify significant differences in TtC and SDoD between experts and novices during CVC needle insertion procedures. In addition, novices were shown to improve their skills through DHRT training.


Asunto(s)
Cateterismo Venoso Central/métodos , Simulación por Computador , Modelos Anatómicos , Cateterismo Venoso Central/normas , Competencia Clínica , Humanos , Internado y Residencia , Análisis de Regresión , Factores de Tiempo
8.
J Emerg Med ; 56(1): 23-28, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30503723

RESUMEN

BACKGROUND: Central vein catheter (CVC) placement using the modified Seldinger technique is a common procedure in the emergency department, but can be time consuming due to the multiple pieces of equipment included in central line kits and the number of steps in the procedure. Preassembled devices combine a needle, guidewire, dilator, and sheath into one unit and potentially simplify the process and reduce time required for CVC placement using the accelerated Seldinger technique. OBJECTIVE: Our aim was to evaluate whether the use of combination central line devices and the accelerated Seldinger technique will reduce the time required to place a CVC and increase the ease of the procedure. METHODS: This two-arm randomized crossover study comparing the accelerated Seldinger technique to the modified Seldinger technique was performed in a simulation setting. Subjects were selected from among emergency physicians, emergency medicine residents, interns, physician assistants, and medical students. Subjects were timed using the modified and accelerated Seldinger techniques. Ease of use and satisfaction data were collected after both procedures. RESULTS: The use of the accelerated Seldinger technique with a combination CVC device was significantly faster compared to the modified Seldinger technique with a standard CVC kit. Procedure time was reduced by 35% (p = 0.001), and ease of use was increased by 7% (p = 0.046), without any increase in errors. CONCLUSIONS: In the simulated setting, the accelerated Seldinger technique using combination CVC devices is a faster and easier method for CVC placement compared to the modified Seldinger technique.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Adulto , Cateterismo Venoso Central/efectos adversos , Estudios Cruzados , Femenino , Humanos , Masculino , Maniquíes , Simulación de Paciente
9.
Intern Emerg Med ; 14(2): 281-289, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30306323

RESUMEN

Central venous oxygen saturation (ScvO2) is easily observable in oncology patients with long-term central venous catheters (CVC), and has been studied as a prognostic factor in patients with sepsis. We sought to investigate the association between ScvO2 and early complications in cancer patients presenting to the ED. We prospectively enrolled adult cancer patients with pre-existing CVC who presented to the ED. ScvO2 was measured on their CVC. The outcome was admission to the intensive care unit (ICU) or mortality by day 7. ScvO2 was first studied as a continuous variable (%) with a ROC analysis and as a categorical variable (cut-off at < 70%) with a multivariate analysis. A total of 210 cancer patients were enrolled. At baseline, ScvO2 showed no significant difference between patients who were admitted to the ICU or died before day 7, and patients who did not (67%; IQR 62-68% vs. 71%; IQR 65-78% respectively, P = 0.3). The ROC analysis showed the absence of discrimination accuracy for ScvO2 to predict the outcome (AUC = 0.56). By multivariate analysis, ScvO2 < 70% was not associated with the outcome (OR 1.67; 95% CI 0.64-4.36). Variables that were associated with ICU admission or death by day 7 included a shock-index (heart rate/systolic blood pressure) > 1 and a performance status > 2 (OR 4.76; 95% CI 1.81-12.52 and OR 6.23, 95% CI 2.40-16.17, respectively). This study does not support the use of ScvO2 to risk stratify cancer patients presenting to the ED.


Asunto(s)
Presión Venosa Central/fisiología , Neoplasias/fisiopatología , Oximetría/normas , Anciano , Área Bajo la Curva , Cateterismo Venoso Central/normas , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neutropenia/etiología , Neutropenia/fisiopatología , Oximetría/métodos , Oxígeno/análisis , Oxígeno/sangre , Paris , Estudios Prospectivos , Curva ROC
10.
J Pediatr Surg ; 54(1): 170-173, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30415958

RESUMEN

PURPOSE: The purpose of this study was to reduce radiation exposure during pediatric central venous line (CVL) placement by implementing a radiation safety process including a radiation safety briefing and a job-instruction model with a preradiation time-out. METHODS: We reviewed records of all patients under 21 who underwent CVL placement in the operating room covering 22 months before the intervention through 10 months after 2013-2016. The intervention consisted of a radiation safety briefing by the surgeon to the intraoperative staff before each case and a radiation safety time-out. We measured and analyzed the dose area product (DAP), total radiation time pre- and postintervention, and the use of postprocedural chest radiograph. RESULTS: 100 patients with valid DAP measurements were identified for analysis (59 preintervention, 41 postintervention). Following implementation of the radiation safety process, there was a 79% decrease in median DAP (61.4 vs 13.1 rad*cm2, P < 0.001) and a 73% decrease in the median radiation time (28 vs 7.6 s, P < 0.001). Additionally, there was a significant reduction in use of confirmatory CXR (95% vs 15%, P < 0.01). CONCLUSION: A preoperative radiation safety briefing and a radiation safety time-out supported by a job-instruction model were effective in significantly lowering the absorbed doses of radiation in children undergoing CVL insertion. TYPE OF STUDY: Case-control study. LEVEL OF EVIDENCE: Level III.


Asunto(s)
Cateterismo Venoso Central/normas , Fluoroscopía/normas , Seguridad del Paciente/normas , Exposición a la Radiación/prevención & control , Radiografía Intervencional/normas , Adolescente , Estudios de Casos y Controles , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/métodos , Niño , Preescolar , Femenino , Fluoroscopía/métodos , Personal de Salud/educación , Humanos , Masculino , Modelos Educacionales , Quirófanos/normas , Dosis de Radiación
11.
J Vasc Access ; 20(3): 239-249, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30286688

RESUMEN

Ultrasound technology has revolutionized the practice of safer vascular access, for both venous and arterial cannulation. The ability to visualize underlying structures of the chest, neck, and upper/lower extremities provides for greater success, speed, and safety with all vascular access procedures. Ultrasound not only yields superior procedural advantages but also provides a platform to perform a thorough assessment of the vascular structures to evaluate vessel health, viability, size, and patency, including the location of other important and best avoided anatomical structures-prior to performing any procedures. Such assessment is best performed using a systematic and standardized approach, as the Rapid Central Vein Assessment, described in this study.


Asunto(s)
Cateterismo Venoso Central/normas , Ultrasonografía Intervencional/normas , Venas/diagnóstico por imagen , Puntos Anatómicos de Referencia , Cateterismo Venoso Central/efectos adversos , Toma de Decisiones Clínicas , Humanos , Guías de Práctica Clínica como Asunto/normas , Valor Predictivo de las Pruebas , Punciones
12.
J Cardiothorac Vasc Anesth ; 33(4): 1029-1034, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30269888

RESUMEN

OBJECTIVE: Visualizing the needle tip using the short-axis out-of-plane (SA-OOP) ultrasound-guided central venous catheterization approach is difficult and results in posterior wall puncture (PWP). To improve needle tip visualization in the long-axis view, combining the SA-OOP and the long-axis in-plane approaches has been suggested. The authors, who previously reported on the utility of this technique using a manikin model, examined the feasibility of this novel method (referred to as the combined short-axis and long-axis [CSLA] approach) and compared the CSLA approach with the SA-OOP approach in humans for the present study. DESIGN: Prospective observational study. SETTING: Single institution, Rakuwakai Otowa Hospital. PARTICIPANTS: Patients undergoing cardiac or vascular surgeries. INTERVENTIONS: The CSLA and SA-OOP approaches were used for ultrasound-guided right jugular venous puncture. The puncturing procedures were determined arbitrarily preoperatively without consideration of the patient's neck anatomy and were based on the operator's preference without randomization. MEASUREMENTS AND MAIN RESULTS: The study comprised 100 patients. Successful guidewire insertion without PWP was performed in 48 patients (96%) in the CSLA approach group and 33 (66%) in the SA-OOP approach group; the rate was significantly higher in the CSLA approach group (p = 0.0001). The procedural durations were 27.5 (range 17.0-122.0) seconds in the CSLA approach group and 25.0 (range 15.0-158.0) seconds in the SA-OOP approach group (p = 0.19). CONCLUSIONS: This study showed that the CSLA approach to ultrasound-guided central venous catheterization might help prevent PWP.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Agujas/normas , Ultrasonografía Intervencional/métodos , Ultrasonografía Intervencional/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ultrasonografía Intervencional/instrumentación
13.
BMC Infect Dis ; 18(1): 606, 2018 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-30509200

RESUMEN

BACKGROUND: Since correct maintenance of intravascular catheters is an effective strategy for preventing central-line infections, the aim of this study was to assess the level of adherence to guidelines for CVC maintenance amongst Italian HCWs. METHODS: From July 2016 thru January 2017, a cross sectional survey was carried out in a random sample of 549 HCWs working in different hospitals of Campania region (Italy). RESULTS: The 68.9% of interviewees returned the questionnaire. Overall, respondents' level of knowledge about CDC guidelines was low, with only the 20.7% of HCWs acknowledging guidelines main recommendations: the nurse stuff, the availability of hospital internal protocols, the use of guidelines themselves as source of information, and higher number of years of practice were significantly associated with a higher level of knowledge. An extremely positive attitude towards the utility of guidelines for preventing CVC-related infections was shown, with a linear regression model indicating a stronger attitude in physicians, in who knew the CDC main recommendations and correct use of antibiotic ointments, as well as in HCWs needing additional information on the prevention of CVC-related infections. Regarding the behaviors, physicians were more likely to be adherent about recommended evidence-based practices. Two more multivariate logistic and ordinal logistic regression models were built to investigate characteristics associated with correct behavior regarding the removal of catheter dressing if patients have tenderness at insertion site or fever without an obvious source, respectively. CONCLUSIONS: This study reflected an important lack of evidence-based knowledge and practices regarding the CVC management, highlighting the baseline role of education and training programs, as well as pointing out the role of organizational interventions to address the adherence to best practices for the reduction of CLABSIs.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Adhesión a Directriz/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Adulto , Cateterismo Venoso Central/estadística & datos numéricos , Catéteres Venosos Centrales/efectos adversos , Catéteres Venosos Centrales/microbiología , Catéteres Venosos Centrales/virología , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Hospitales/normas , Hospitales/estadística & datos numéricos , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
14.
Indian Pediatr ; 55(9): 753-756, 2018 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-30345978

RESUMEN

OBJECTIVE: To study the impact of a quality improvement (QI) initiative using care bundle approach on Central-line associated bloodstream infections (CLABSI) rates. METHODS: A QI team for infection control in NICU was formed in a tertiary-care neonatal intensive care unit (NICU) from June 2015 to August 2016. Baseline data were collected over first 3 months followed by the intervention period of 1 year. Measures with respect to strengthening hand hygiene and central line bundle care were implemented during the intervention period. Audits assessing the compliance to hand hygiene and CLABSI bundle protocols were used as process indicators. Multiple PDSA cycles were used to strengthen the practices of proposed interventions, documentation of data and audits of the processes during the study period. RESULTS: The QI initiative achieved a 89% reduction in CLABSI from the baseline rate of 31.7 to 3.5 per 1000 line-days. The blood stream Infections reduced from 7.3 to 2.3 per 1000 patient-days. The overall mortality showed a reduction from 2.9% to 1.7% during the intervention period. There was a significant improvement in compliance with hand hygiene protocol and compliance with CLABSI protocols. CONCLUSION: This study demonstrated that simple measures involving hand hygiene and strengthening of the care bundle approach through quality improvement could significantly reduce the blood stream Infections and CLABSI rates.


Asunto(s)
Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/normas , Control de Infecciones/normas , Unidades de Cuidado Intensivo Neonatal/normas , Mejoramiento de la Calidad , Bacteriemia/epidemiología , Bacteriemia/etiología , Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/mortalidad , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Adhesión a Directriz/estadística & datos numéricos , Higiene de las Manos , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Control de Infecciones/métodos
15.
J Healthc Qual ; 40(6): 392-397, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30362998

RESUMEN

This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare requires organizations to understand care delivery and to proactively mitigate risks in care delivery processes. The purpose of this article is to describe a quality initiative that used principles of high reliability to develop a zero tolerance culture for central line-associated bloodstream infections in an intensive care unit at an independent, nonprofit acute care community hospital.


Asunto(s)
Bacteriemia/prevención & control , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/normas , Infección Hospitalaria/prevención & control , Prestación de Atención de Salud/normas , Unidades de Cuidados Intensivos/normas , Calidad de la Atención de Salud/normas , Humanos , Guías de Práctica Clínica como Asunto , Reproducibilidad de los Resultados , Estados Unidos
16.
Artículo en Alemán | MEDLINE | ID: mdl-29945286

RESUMEN

This guideline was presented in 2016 due to the need for an up to date evidence-based guidance focusing on patient safety. In addition to safety-related aspects of catheter insertion or removal, organisational issues and structured training concepts were discussed. The guideline was created based on the review of current literature as well as expert opinion. The article summarizes and discusses the most important recommendations and the reader is provided with practical advice for catheter insertion or removal with the intention to improve the safety of the patients.


Asunto(s)
Cateterismo/normas , Dispositivos de Acceso Vascular , Anestesiología/normas , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo/efectos adversos , Cateterismo Venoso Central/normas , Cateterismo Periférico/normas , Guías como Asunto , Humanos , Infusiones Intraóseas , Irlanda , Seguridad del Paciente , Reino Unido , Dispositivos de Acceso Vascular/efectos adversos
18.
BMC Med Educ ; 18(1): 154, 2018 Jun 28.
Artículo en Inglés | MEDLINE | ID: mdl-29954376

RESUMEN

BACKGROUND: Despite the widespread implementation of competency-based education, evidence of ensuing enhanced patient care and cost-benefit remains scarce. This narrative review uses the Kirkpatrick/Phillips model to investigate the patient-related and organizational effects of graduate competency-based medical education for five basic anesthetic procedures. METHODS: The MEDLINE, ERIC, CINAHL, and Embase databases were searched for papers reporting results in Kirkpatrick/Phillips levels 3-5 from graduate competency-based education for five basic anesthetic procedures. A gray literature search was conducted by reference search in Google Scholar. RESULTS: In all, 38 studies were included, predominantly concerning central venous catheterization. Three studies reported significant cost-effectiveness by reducing infection rates for central venous catheterization. Furthermore, the procedural competency, retention of skills and patient care as evaluated by fewer complications improved in 20 of the reported studies. CONCLUSION: Evidence suggests that competency-based education with procedural central venous catheterization courses have positive effects on patient care and are both cost-effective. However, more rigorously controlled and reproducible studies are needed. Specifically, future studies could focus on organizational effects and the possibility of transferability to other medical specialties and the broader healthcare system.


Asunto(s)
Anestesia/métodos , Anestesiología/educación , Competencia Clínica , Educación Basada en Competencias , Anestesia/efectos adversos , Anestesia/economía , Anestesiología/economía , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/normas , Educación Basada en Competencias/economía , Análisis Costo-Beneficio , Educación de Postgrado en Medicina/métodos , Educación de Postgrado en Medicina/normas , Humanos , Aprendizaje , Atención al Paciente
20.
Simul Healthc ; 13(3): 163-167, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29863604

RESUMEN

INTRODUCTION: Within simulation-based mastery learning (SBML) courses, there is inconsistent inclusion of learner pretesting, which requires considerable resources and is contrary to popular instructional frameworks. However, it may have several benefits, including its direct benefit as a form of deliberate practice and its facilitation of more learner-specific subsequent deliberate practice. We consider an unexplored potential benefit of pretesting: its ability to predict variable long-term learner performance. METHODS: Twenty-seven residents completed an SBML course in central line insertion. Residents were tested on simulated central line insertion precourse, immediately postcourse, and after between 64 and 82 weeks. We analyzed pretest scores' prediction of delayed test scores, above and beyond prediction by program year, line insertion experiences in the interim, and immediate posttest scores. RESULTS: Pretest scores related strongly to delayed test scores (r = 0.59, P = 0.01; disattenuated ρ = 0.75). The number of independent central lines inserted also related to year-delayed test scores (r = 0.44, P = 0.02); other predictors did not discernibly relate. In a regression model jointly predicting delayed test scores, pretest was a significant predictor (ß = 0.487, P = 0.011); number of independent insertions was not (ß = 0.234, P = 0.198). CONCLUSIONS: This study suggests that pretests can play a major role in predicting learner variance in learning gains from SBML courses, thus facilitating more targeted refresher training. It also exposes a risk in SBML courses that learners who meet immediate mastery standards may be incorrectly assumed to have equal long-term learning gains.


Asunto(s)
Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Competencia Clínica/normas , Internado y Residencia/normas , Entrenamiento Simulado/normas , Evaluación Educacional , Humanos
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