Sepsis Module: An Educational Tool for the Management of Sepsis Author: Han-Oh Chung, Damien Medina Date: September 28 th 2013
I have/had an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Funding was provided through an educational grant from Pfizer administered through the Royal College PPI branch. Author: Han-Oh Chung Date: September 28 th 2013
Outline Background Educational Theory Pilot Data Results Discussion 3
Background There is a lack of comprehensive, multidisciplinary educational resources available to non-critical care personnel to help improve knowledge and practical management of sepsis We recognize that non-critical care physicians, RNs and RTs are among the first healthcare professionals to encounter sepsis early in the presentation. There have been many new advances and evidencebased changes in the management of sepsis and its associated complications in the recent years (i.e. 2012 Surviving Sepsis Campaign ) 4
Education Theory Education on sepsis guidelines can improve performance and mortality 1,2,3,4 Interdisciplinary education helps improve practice performance by enhanced mutual understanding, decrease errors and barriers to expedient care 5,6 Simulation-Based Medical Education can create an arena for team-based learning through the recreation of real life clinical scenarios. Highly effective in resuscitation training 7,8 5
Methods RC-Sims Hifidelity Sim Pre-test Lecture Post-test Hifidelity Sim RC-Sims 6
Outcomes Quantitative measures:» Primary outcome was of knowledge transfer by use of a pre-test and post-test» Significance was analyzed by use of paired t-test Qualitative measures:» Self-assessment questionnaires were created for different CanMEDS roles and general value of the course» Scored by Likert scales and written comments» Major thematic clusters were evaluated 7
Results Pre-test Mean 75% 85% p-value (paired t- test) Post-test 0.0001 Results were significant when analyzed between different specialties and training level 8
Theme: Clinical Preparedness Practical value in the education module as a self learning tool Communication with SBAR principle useful Mixture of lecture and practical simulation with direct feedback helpful in rapid knowledge gain and consolidation Really changes your knowledge and capabilities overnight. Would change the way I practice much faster than reading a textbook 9
Theme: Improved Collaboration Collaboration between different specialties a welcome new experience Participants valued the interdisciplinary input and collaboration of the RTs and RNs The first valuable interprofessional designed arena that has been successful (that I have been a part of) 10
8 Month Follow-up Mean test score was 87.9% I have utilized the knowledge learned in the course in the past year» 63% agree or strongly agree During this past year, I have used the skills gained in the course to communicate effectively in crisis situations» 72% agree or strongly agree The experience of this course has allowed me to work more collaboratively in the past year» 72% agree or strongly agree 11
Strengths High impact clinical entity known to be amenable to education. Brings together high-fidelity and low-fidelity simulation to allow advantages of both teaching models. Interprofessional and interdisciplinary model of teaching. No significant degradation of knowledge in follow-up. Applicable to wide range of training levels and specialty. Easily incorporated into simulation curriculum. 12
Limitations Sample Size Time limitation» Pilot study does not allow for prolonged deliberate practice Kirkpatrick level 2 13
Current Progress Sim-One / Canadian Patient Safety Institute funded study in a community hospital Database of sepsis performance markers and outcomes in sepsis patients 13 MDs (along with 8 RNs, RTs) have gone through the module so far. Will be able to follow short term performance and outcome per MD. 14
Thank you Questions? Han-Oh Chung, MD, FRCPC Damien Medina, MB BCh BAO, FRCPC Alison Fox-Robichaud, MD MSc FRCPC Roman Jaeschke, MD FRCPC Benjamin Lo, MD PhD FRCSC Joshua Peachey MD Angele Landriault RN (PPI Unit Royal College) Travis Gould PhD Candidate 15
References 1. Nguyen HM, Schiavoni A, Scott KD, Tanios MA. Implementation of sepsis management guideline in a community-based teaching hospital - can education be potentially beneficial for septic patients? Int J Clin Pract 2012;66(7):705 10. 2. Ferrer R, Artigas A, Levy MM, et al. Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 2008;299(19):2294 303. 3. Sebat F, Musthafa AA, Johnson D, et al. Effect of a rapid response system for patients in shock on time to treatment and mortality during 5 years. Critical Care Medicine 2007;35(11):2568 75. 4. Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Critical Care Medicine 2010;38(2):367 74. 5. Kyrkjebø JM, Brattebø G, Smith-Strøm H. Improving patient safety by using interprofessional simulation training in health professional education. J Interprof Care 2006;20(5):507 16. 6. Hunziker S, Johansson AC, Tschan F, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol 2011;57(24):2381 8. 7. McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003-2009. Med Educ 2010;44(1):50 63. 8. Mundell WC, Kennedy CC, Szostek JH, Cook DA. Simulation technology for resuscitation training: A systematic review and meta-analysis. Resuscitation 2013;84(9):1174 83. 16
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