Physician harnesses simulation to combat central line complications

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are a major concern for hospitals and the healthcare sector, costing money and—most importantly—harm to patients. These complications are also highly preventable, as demonstrated by expert Dr. Yanick Beaulieu.

Central line (also “central venous”) complications include placement failure of catheters and arterial punctures, as well as central line infections (CLIs). The reduction of CLIs, which is caused when a central venous catheter placed in a patient’s vein gets infected, is a particularly concern. For example, the Ontario Ministry of Health and Long Term Care (MOHLTC) now requires that all eligible hospitals submit data elements for CLIs in an effort to improve patient care and patient safety.

Dr. Beaulieu—a cardiologist at Hôpital Sacré-Coeur de Montréal and is an Assistant Professor at Université de Montréal—believes the best way to reduce central line complications is through ultrasound-guided simulation-based . A renowned expert in ultrasound simulation, Dr. Beaulieu—along with colleague Dr. Robert Amyot—co-founded CAE’s Vimedix ultrasound simulator, a high-fidelity simulators that enables users to view internal organs via ultrasound.

He says simulation helps build confidence and competence in healthcare professionals.

“There is a big clinical need for goal-directed, high-quality ,” says Dr. Beaulieu, who is also the Director of Ultrasound Education at CAE Healthcare, one of the world’s largest simulation enterprises. “Simulation has a major impact on improving patient care and improves outcomes…being able to bring this to the patient is very satisfying.”

Research suggests that ultrasound-guided simulation-based education can have a positive effect in reducing central line complications. For example, in a study conducted by H. Sekiguchi et al, entitled, “A Prerotational, Simulation-Based Workshop Improves the Safety of Central Venous Catheter Insertion”, the placement failure rate of central line decreased from 22.8 per cent to 16.2 per cent and arterial punctures decreased from 4.2 per cent to 1.5 per cent amongst test subjects following a simulation-based workshop. The results of the study were published in June 2011 in Chest, the official publication of the American College of Chest Physicians, and can be viewed online.

Dr. Beaulieu is also conducting his own research study using an ultrasound-guided simulation-based procedure course for central line insertion he developed and that has been packaged in the CAE ICCU e-learning management system (LMS). The project compares competency in central line insertion between first-year and third-year medical residents at Université de Montréal. The first-year residents have previously received training in ultrasound-guided simulation while the third-year residents—who participate on a volunteer basis—have not.

Though the study has not been completed, Dr. Beaulieu says preliminary results have already shown increases in competency in junior residents. Dr. Beaulieu expects to have an abstract of the study completed by December of this year.

Dr. Beaulieu is working to expand the use of ultrasound-guided simulation for central line insertion to other professions. For example, he is currently developing an ultrasound-guided simulation-based curriculum for nurses.

“A full curriculum combining e-learning and simulation entitled, “Ultrasound-guided peripheral vascular access for nurses” has been designed and is currently in the process of being finalized,” says Dr. Beaulieu

He says that the curriculum should be ready by January 2012. Any hospital will then be able to implement the curriculum into their environment.

On December 1, 2011, Dr. Beaulieu will be highlighting his important work at the Ontario Simulation Exposition in Toronto. The Ontario Simulation Exposition is an annual event hosted by SIM-one—the Ontario Simulation Network—that celebrates the achievements of the province’s healthcare simulation community.