Board 404 - Research Abstract Evaluation of Simulation Education using Anesthesia Information System (Submission #99)

Abstract

Introduction/Background The use of high-fidelity patient simulation is a validated educational tool for anesthesiology resident training, especially for novice residents.1 Simulation has the advantage of teaching students clinically applicable skills and judgment without risking patient harm. Documentation of improved speed with acquisition of technical skills, such as fiberoptic intubation2 and central line placement,3 has been published but very few studies have been able to demonstrate a correlation between high-fidelity simulation education and improvement in patient outcomes. Wayne et al4 have demonstrated that simulation-based education of internal medicine residents in ACLS and code blue training resulted in an improved adherence to ACLS protocols during actual hospital code blue events. Barsuk et al5 showed that resident simulation-based training can reduce catheter related blood stream infections. Aside from these few small studies, there is little data to substantiate the belief that simulation-based education Results in improved patient outcomes. This study examines the effect of simulation on the treatment of emergence of hypertension through the examination of EMR records. Methods IRB was obtained through UC Irvine Simulation Center. Participants were anesthesiology resident volunteers. Each resident participated in a simulation which contained a patient with hypertension at emergence. The simulation session included a 20 minute scenario participation followed by a 40 minute debriefing. Pharmacologic treatment of hypertension was reviewed during the debriefing. The simulation scenario was the same for each participant. Surgical Information Systems (SIS) is the Anesthesia Information Management System (AIMS) or electronic anesthesia medical record at UC Irvine Medical Center. The electronic anesthesia records of each participant were then searched for the cases one month prior to the simulation education sessions to evaluate whether or not hypertension at emergence was treated pharmacologically. Emergence was defined as within 30 minutes of extubation and hypertension was defined as mean arterial pressure (MAP) 20% greater than baseline. The month following the simulation was later searched in UC Irvine AIMS to determine whether hypertension at emergence was treated by participants or not. We used the Related-Samples Wilcoxon Signed Rank test to compare the median proportion treated before and after simulation. Results Eleven residents participated in the study. One participant was excluded because they went onto outside rotations and data could not be evaluated. During the month prior to the simulation, a total of 53 patients had a MAP greater than 20% baseline and in 26 (43%) of these cases the hypertension was treated pharmacologically by the participant. The median percentage of cases per participant treated pre-simulation was 50% [10.7, 67.6]. In the month following the simulation, a total of 53 cases had a MAP greater than 20% baseline and in 35 (66%) of these cases the hypertension was treated pharmacologically. The calculated median percentage of cases per participant treated post-simulation 65.7% [48.6, 81.2], which is statistically significant (p = 0.037). Conclusion Following the simulation session, participants did show an increase in the percentage of cases of emergence hypertension treated pharmacologically. More participants are needed to draw conclusive Results. AIMS can be a used as a tool when evaluating the impact of simulation on clinical outcomes.