158 Caring for a Critically Ill Simulated Left Ventricular Assist Device Patient With or Without a Cognitive Aid Improves Physician Comfort

Abstract

The number of left ventricular assist devices (LVADs) implanted is increasing yearly. Despite this growing number, physician education on this patient population remains inconsistent. High fidelity simulation is a useful tool for education and assessment in the health care setting. Using high fidelity simulation, we sought to assess the comfort level of our emergency department (ED) providers caring for critically ill LVAD patients, with and without the use of an adjunctive cognitive aid (Figure 1). We modified our Laerdal 3G SimMan to reflect an LVAD patient by decreasing the volume of his heart tones, turning off peripheral pulses and by placing a personal stimulation device in the chest cavity. In collaboration with our LVAD team, we developed a cognitive aid to assist in the care of critically ill LVAD patients. Twenty physician teams cared for a simulated LVAD patient who was suffering from a gastrointestinal bleed and a suction event. Groups were composed of one attending and 1-2 emergency medicine resident physicians at various stages of training (PGY 1-3). The first 10 scenarios were managed without access to our cognitive aid; the second 10 groups had access to our cognitive aid. Participants were evaluated based on 11 predetermined critical actions for the case and completed a pre and post-simulation survey to evaluate their baseline experience with LVAD patients and their comfort levels pre and post simulation. The majority of caregivers (96%) care for < 5 LVAD patients per month. 74% of participants had cared for less than 30 LVAD patients in their career. We found no significant differences in a team’s delivery of appropriate care whether a cognitive aid was utilized or not (p<0.05). 92% of participants who were given the aid felt it was useful and 100% would use it during patient care. After participating in the simulation, all participants felt significantly more comfortable taking care of hypotensive (p<0.05) and crashing (p<0.05) LVAD patents. Although participants felt the cognitive aid would be useful, our data supports that participation in the simulation increased physician comfort level regardless of the cognitive aid. LVAD placements are increasing nationally. Simulation may increase an ED provider’s comfort level in caring for unstable LVAD patients. For those providers who cannot participate in simulation, a cognitive aid that outlines common LVAD emergencies may also be useful.View Large Image Figure ViewerDownload Hi-res image Download (PPT)