Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.
BACKGROUND
Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents.


METHODS
This was an intervention evaluation study estimating cost savings related to a simulation-based intervention in central venous catheter (CVC) insertion in the Medical Intensive Care Unit (MICU) at an urban teaching hospital. After residents completed a simulation-based mastery learning program in CVC insertion, CRBSI rates declined sharply. Case-control and regression analysis methods were used to estimate savings by comparing CRBSI rates in the year before and after the intervention. Annual savings from reduced CRBSIs were compared with the annual cost of simulation training.


RESULTS
Approximately 9.95 CRBSIs were prevented among MICU patients with CVCs in the year after the intervention. Incremental costs attributed to each CRBSI were approximately $82,000 in 2008 dollars and 14 additional hospital days (including 12 MICU days). The annual cost of the simulation-based education was approximately $112,000. Net annual savings were thus greater than $700,000, a 7 to 1 rate of return on the simulation training intervention.


CONCLUSIONS
A simulation-based educational intervention in CVC insertion was highly cost-effective. These results suggest that investment in simulation training can produce significant medical care cost savings.
Cohen
Elaine R
ER
Department of Medicine, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL 60611, USA. elaine-cohen@northwestern.edu
Feinglass
Joe
J
Barsuk
Jeffrey H
JH
Barnard
Cynthia
C
O'Donnell
Anna
A
McGaghie
William C
WC
Wayne
Diane B
DB
D017848:Blood-Borne Pathogens; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000191:economics / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003198:Computer Simulation / Q000191:economics; D017046:Cost Savings / Q000379:methods; D003362:Cost-Benefit Analysis; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008348:Manikins; D008875:Middle Aged; D012044:Regression Analysis