Use of simulation to improve ventricular assist device self-management

Project Summary Over 5.1 million Americans suffer from heart failure (HF), leading to an annual estimated $32 billion societal cost. Although survival from HF has improved, a diagnosis of HF is similar to some forms of cancer, with 50% of patients dying within 5 years. Ventricular assist devices (VADs) have improved survival in patients with advanced HF. Over 17,000 patients with advanced HF received VADs in the last decade. VAD devices are surgically implanted into the heart and provide circulatory support to the patient. A driveline passes from the device through the skin, connecting to a system controller that in turn is connected to a power source. Risks after VAD implantation include life-threatening driveline infections that can lead to device malfunction. At the time of VAD implantation, patients and their caregivers are educated about VAD self-management. After discharge, patients and caregivers are required to engage in daily VAD self-management and recognize VAD-specific signs and symptoms requiring immediate medical attention. With improper VAD self-management, patients can die from preventable complications. Unfortunately, no rigorous standardized training exists for patients and caregivers to ensure mastery of VAD self-management. Traditionally, VAD training consists of patients and their caregivers watching a video or demonstrating VAD-related techniques and then performing these techniques, first under supervision, and within days, independently. This process leads to uneven skill acquisition and may cause unnecessary harm to the patient. Simulation-based mastery learning (SBML) can be used to prevent such uneven skill acquisition and potential patient harm. SBML is an intense form of competency-based education in which learners are required to meet or exceed a predetermined high level of skill on a simulator. Our research demonstrates that SBML is a more effective strategy than traditional education in improving clinical skills and patient care. Therefore, we propose to create and test an SBML intervention for VAD self-management and compare the intervention to traditional (usual) VAD training. Our specific study aims are to: AIM 1. A) Complete semi-structured interviews with nurses, physicians, patients and caregivers to identify common and unique barriers and facilitators encountered regarding VAD self-management. B) Develop an SBML VAD self-management curriculum informed by the interviews and current best practices. AIM 2. Compare performance of VAD self-management skill of sterile dressing changes and VAD-related controller functions between SBML-trained and the usual training group immediately following training, and at one month and three months after VAD implantation. AIM 3. This exploratory aim will examine VAD-patient driveline infections, and all-cause and infection-related re-hospitalizations at one and three months, between the SBML intervention group as compared to the usual training group.