PG1 Quality improvement project: implementation of a central venous catheter insertion course to improve trainees procedural skills and patient care

Abstract

Background We describe a QI project designed to improve junior doctors’ skills in performing central venous catheter (CVC) insertion in a tertiary cardiac centre. Feedback from local Core Medical Trainees suggested that junior doctors in the local deanery sought further training in core procedural skills, especially in CVC insertion. Trainees reported low confidence in this procedure and felt formal training would improve their ability to provide better patient care, particularly in emergency settings. Therefore, using quality improvement methodology, we set up a local course on CVC insertion to address this skill gap. Project description The four-step PDSA model was utilised to improve trainee’s practical skills in CVC insertion. Plan: A CVC insertion course was planned for junior doctors. Do: Five half-day courses were run over two years between 2018–2019 at our local Simulation, Training and Resource (STaR) Centre in Harefield Hospital. Study: Feedback from candidates was gathered after each course, and pre- and post-course tests were utilised to assess learning. Act: From this feedback, changes were made to the course and other training pathways introduced. This cycle was repeated several times. Outcome Forty four candidates attended five courses run at the STaR Centre at Harefield Hospital over a period of two years from 2018–2019. Feedback from the courses was unanimously positive and comparison of pre- and post-course test scores demonstrated both candidate learning and increased confidence in performing the procedure in clinical settings. Feedback from the CVC training days also suggested that trainees desired further training with real patients in a supportive environment. Therefore, as part of a second PDSA cycle a local training pathway was set up to enable trainees to attend a theatre day where they conducted supervised insertion of CVCs into patients undergoing cardiac surgery. Discussion This QI project demonstrates the benefit of developing sustainable training programmes locally in response to educational need, in a learner-lead way by allowing junior doctors to identify training gaps which they feel impact on patient care. This local CVC insertion course gave rise to a training programme of CVC insertion in theatres led by consultant anaesthetists within Harefield Hospital. Positive impact on patient care has been inferred from trainee feedback suggesting they were significantly more confident in safely performing the procedure in clinical settings after this training.