PS4-07: BEST PRACTICE PROGRAM FOR CENTRAL VENOUS CATHETER INSERTION: 3 YEARS OF REFINEMENT
Tiffany N Anderson, MD, Richard W Sapp, MS, Edmund W Lee, MD, Sylvia B Merrell, DrPh, Laura Mazer, MD, Cara Liebert, MD, Dana Lin, MD, James Lau, MD, MHPE; Stanford University

Introduction: A number of well established systematic training programs for central venous catheter insertions (CVCI) have been described and shown to reduce infectious and mechanical complications.  However, data is limited on assessment instruments for these curricula. Three years ago we developed an interactive multimodal curriculum and assessment tool for CVCI, grounded in experiential learning principles for first year general surgery residents.  We present the validity evidence of our assessment tool from this simulation-based CVCI verification of proficiency (VOP) program.

Methods: Following evidence-based best practice guidelines, our educational course includes instruction on basic anatomy, ultrasound physics and imaging, Seldinger technique, detection/management of complications, and maintenance of central venous catheters.  The required curriculum consisted of online pre-work with knowledge assessment followed by in-person simulation-based practice and testing via a formal VOP. Our assessment tool is a binary checklist of 31 items that requires minimal rater training. Utilizing Classical Test Theory, we conducted item analysis to calculate the discrimination factor for each item and Cronbach’s alpha of the assessment.  Hospital privileges were contingent on successful completion of the curriculum.

Results: Ninety-nine surgical residents participated in the CVCI curriculum from June 2015 to July 2018.  Ninety-eight (98%) were PGY1. Of the PGY1s, 35% were female. Less than half (40%) of residents did not demonstrate proficiency the first time and subsequently achieved competency with approximately one hour of additional facilitated practice time.  Appropriate needle placement and handling had the highest correlation for successful demonstration of proficiency (.80). Confirming venous blood return was the task that correlated lowest with success (.21). The internal-consistency reliability of the assessment was 0.84.

Discussion: With this pilot curriculum, we have demonstrated robust internal consistency and tasks correlated with success of our assessment tool which provides validity evidence to support the high-stakes consequences that we have set for our residents.  The program’s success has prompted other departments in our institution to seek to adopt it for their own trainees and staff. Ultimately, we will continue to develop and refine these best practice programs as we strive to eliminate avoidable medical errors and ensure optimal patient safety.