Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

Khushboo Qaim Ali,Hasan Merali,Shaun Morris,Shabina Ariff,Mark Oliver Tessaro,Uzair Ansari,Ali Shabbir Hussain,Sajid Bashir Soofi

doi:10.1186/s12909-020-02338-4

Khushboo Qaim Ali, Hasan Merali + Show 6 more

Open Access

https://doi.org/10.1186/s12909-020-02338-4

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Abstract

BackgroundSimulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts.MethodsSixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations.ResultsThe majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p < 0.001. There was an average reduction of 1.3 s (β = − 1.3; 95% CI: − 1.66 to − 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above.ConclusionWe found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings.Trial registrationClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

Highlights

Simulators are an extensively utilized teaching tool in clinical settings
We found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of endotracheal tube (ETT) position using point-of-care ultrasound (POCUS)
We investigated the usefulness of a lowcost, novel POCUS simulator to train health care providers with minimal or no POCUS experience to accurately detect tracheal versus esophageal intubation in neonates

Summary

Introduction

Simulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. Simulation-based training has been shown to decrease medical errors and provide a platform to enhance learner knowledge, clinical skills and performance in a controlled environment that translates to improved patient care [3,4,5,6,7,8]. Numerous homemade simulators have been used for training in interventional skills such as central venous access, chest tube insertion,umbilical artery catheterization and airway procedures such as tracheostomy and cricothyrotomy [9]. The 2030 Lancet Commission on Global Surgery meeting suggested the use of locally available and affordable models for training in low- and middle-income countries (LMICs) [13] These cost-effective models have proven efficacious for simulation-based training in achieving expertise in many clinical tasks [11] including Point of care ultrasound (POCUS) [14]

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