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Economic Impact of Simulation-Based Training (SBT) for Central Venous Catheter (CVC) Insertion

2015; Elsevier BV; Volume: 18; Issue: 3 Linguagem: Inglês

10.1016/j.jval.2015.03.1381

1524-4733

Carl V. Asche, Lisa Barker, Jinma Ren, M. Kim, Carmen S. Kirkness, Jeremy McGarvey, Jerry Short, John A. Vozenilek,

Patient Safety and Medication Errors

CVC insertion is one of the most commonly performed medical procedures in the intensive care hospital setting. The clinical impact of SBT in the procedure has been demonstrated previously. However, little is known about the economic impact of such educational interventions. This study aimed to analyze the costs associated with outcomes attributable to the implementation of a SBT program for CVC insertion. The SBT training interventions were implemented for residents working in the MICU at OSF St. Francis Medical Center in Peoria, Illinois, from 09/01/2012 to 12/31/2013. Data from an historical control group (traditional training) was selected during a parallel time period from 09/01/2010 to 12/31/2011. Collected information included total hospital cost, training cost, LOS, complications, and patient demographics. Costs were adjusted to 2014 dollars. Adjusted generalized linear models were used to estimate the margin effects for the cost and the effectiveness. 86 residents placed 353 CVC lines in patients with an average patient age of 63.4 (±15.8) years in the SBT group, and 81 residents placed 262 CVC catheter lines in patients with an average age of 62.8 (±15.2) years in the control group. Compared to the traditional training, the SBT was a dominant case with cost-saving (-$5,062, p=0.002), and reductions of overall complications (3.9%, p=0.017) and severe complications (3%, p=0.043) per admission, resulted in the incremental cost-effectiveness ratios of -$1,298 (= -$5,062/3.9%) and -$1,687 (= -$5,062/3.0%) per 1% averted probability of overall and severe complications gained, respectively. The total benefit cost ratio was 10.2. Even in the first year, the SBT demonstrated a high return on investment (ROI) of 649% with a $4,863 net benefit per admission. The ROI could reach 934% and 986% in 5 years and 10 years, respectively. Using SBT for CVC insertion is a cost-effective approach that can be widely implemented.