Improving delivery of continuous renal replacement therapy: Impact of a simulation-based educational intervention

PURPOSE: To describe our experience with transitions in both nursing model and educational training program for delivery of continuous renal replacement therapy. There have been very few comparisons between different care and educational models, and the optimal approach remains uncertain. In particular, we evaluated our experience with introducing a simulation-based educational model. DESIGN: Prospective quality control observational study. SETTING: The ICU of a tertiary care pediatric referral center. PATIENTS: All patients undergoing CRRT between July 2007 through July 2010 were included. MEASUREMENTS AND MAIN RESULTS: We monitored CRRT filter life during a transition from a collaborative to critical care nursing model, and subsequently during a transition from a didactic education program to simulation-based training. During the study period, 80 patients underwent continuous renal replacement therapy with use of 343 filters. Process control charts demonstrated a significant increase in filter life and a decrease in unplanned filter changes. Both of these signals emerged at the same time and corresponded with the introduction of the simulation-based education program. Further statistical analysis showed that filter life improved from 42.5 hours (18.2-66.4 hr) during the didactic education program to 59.4 hours (22.2-76.4 hr) during the simulation-based education program (p = 0.008). This relationship persisted when excluding nonpreventable premature filter discontinuations and in a multivariate model that accounted for other potential influences on filter life. CONCLUSIONS: We report on the impact of transitioning between different educational programs for continuous renal replacement therapy, specifically with the introduction of a simulation-based approach. We observed a significant and sustained improvement in the delivery of continuous renal replacement therapy as demonstrated by a marked increase in filter lifespan.