title: Attending Physician Adherence to a 29-Component Central Venous Catheter Bundle Checklist During Simulated Procedures.
abstract: OBJECTIVE
  Central venous catheter insertions may lead to preventable adverse events. Attending physicians' central venous catheter insertion skills are not assessed routinely. We aimed to compare attending physicians' simulated central venous catheterinsertion performance to published competency standards.
  
  
  METHODS
  Prospective cohort study of attending physicians' simulated internal jugular and subclavian central venous catheter insertion skills versus a historical comparison group of residents who participated in simulation training.
  
  
  METHODS
  Fifty-eight Veterans Affairs Medical Centers from February 2014 to December 2014 during a 2-day simulation-based education curriculum and two academic medical centers in Chicago.
  
  
  METHODS
  A total of 108 experienced attending physicians and 143 internal medicine and emergency medicine residents.
  
  
  METHODS
  None.
  
  
  RESULTS
  Using a previously published central venous catheter insertion skills checklist, we compared Veterans Affairs Medical Centers attending physicians' simulated central venous catheter insertion performance to the same simulated performance by internal medicine and emergency medicine residents from two academic centers. Attending physician performance was compared to residents' baseline and posttest (after simulation training) performance. Minimum passing scores were set previously by an expert panel. Attending physicians performed higher on the internal jugular (median, 75.86% items correct; interquartile range, 68.97-86.21) and subclavian (median, 83.00%; interquartile range, 59.00-86.21) assessments compared to residents' internal jugular (median, 37.04% items correct; interquartile range, 22.22-68.97) and subclavian (median, 33.33%; interquartile range, 0.00-70.37; both p < 0.001) baseline assessments. Overall simulated performance was poor because only 12 of 67 attending physicians (17.9%) met or exceeded the minimum passing score for internal jugular central venous catheter insertion and only 11 of 47 (23.4%) met or exceeded the minimum passing score for subclavian central venous catheter insertion. Resident posttest performance after simulation training was significantly higher than attending physician performance (internal jugular: median, 96%; interquartile range, 93.10-100.00; subclavian: median, 100%; interquartile range, 96.00-100.00; both p < 0.001).
  
  
  CONCLUSIONS
  This study demonstrates highly variable simulated central venous catheter insertion performance among a national cohort of experienced attending physicians. Hospitals, healthcare systems, and governing bodies should recognize that even experienced physicians require periodic clinical skill assessment and retraining.
authors.affiliation: 1Department of Medicine, Northwestern University Feinberg School of Medicine; Chicago, IL.2Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL.3The Simulation Learning, Education and Research Network (SimLEARN), Veterans Health Administration, Orlando, FL.4Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Barsuk
authors.forename: Elaine R
authors.initials: ER
authors.lastname: Cohen
authors.forename: Duyhuu
authors.initials: D
authors.lastname: Nguyen
authors.forename: Debi
authors.initials: D
authors.lastname: Mitra
authors.forename: Kelly
authors.initials: K
authors.lastname: O'Hara
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Okuda
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: Kenzie A
authors.initials: KA
authors.lastname: Cameron
authors.forename: William C
authors.initials: WC
authors.lastname: McGaghie
authors.forename: Diane B
authors.initials: DB
authors.lastname: Wayne
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002405:Catheterization, Central Venous / Q000379:methods* / Q000592:standards*; D057189:Checklist; D002641:Chicago; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008348:Manikins; D008875:Middle Aged; D008954:Models, Biological; D010820:Physicians / Q000592:standards*; D011446:Prospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs