require prolonged drug delivery, such as cancer patients, in the United States annually. Unfortunately, this common procedure can result in numerous complications for nearly a million of those cases. To address this issue, researchers have created a robotic simulation training program to offer trainee physicians additional practice in performing the procedure. After implementing the program for a year, the team discovered a significant decrease in all types of complications, including mechanical problems, infections, and blood clots. This signifies a positive impact on patient safety and overall procedure success.The United States sees the need for prolonged drug delivery in many patients every year, especially those undergoing cancer treatments. However, this common procedure can lead to complications in almost a million cases. In order to reduce the rate of infections, blood clots, and other issues associated with placing a central line catheter, Penn State researchers have created an online curriculum and hands-on simulation training for trainee physicians to get more practice.
This training was implemented in 2022 at the Penn State College of Medicine, and the researchers have recently evaluated how it has affected the prevalence of central…The researchers examined the impact of central line placement training on reducing complications by comparing error rates in 2022-23, after the training was fully implemented, to two previous years, 2016-17 and 2017-18, before the training was in place. They discovered that all types of complications — including mechanical issues, infections, and blood clots — were notably lower after the training was initiated. Their findings were published in the Journal of Surgical Education. The researchers have patents on the technology used in this study. They are also using the same approach to improve other common procedures with high complication rates.including colonoscopies and laparoscopic surgeries, is being reevaluated. Scarlett Miller, a professor at Penn State, believes that their new approach can significantly reduce preventable errors in clinical practice. This approach aims to bridge the gap between clinical education and practice by ensuring that physicians in residency training are fully proficient in essential skills such as placing central lines. This, in turn, can minimize the risk to patients’ lives. The traditional training methods for routine surgical procedures are being reconsidered in light of these findings.The process typically begins with a junior doctor observing a more experienced doctor perform the procedure. After that, the junior doctor is required to carry out the procedure themselves, and eventually, they will teach someone else how to do it. However, this approach has its drawbacks, as there are minimal safety checks in place and the junior doctor can only improve by practicing on actual patients, who are at risk of complications,” Miller explained. “The simulation approach, on the other hand, allows individuals to practice the procedure hundreds or even thousands of times without putting any patients in danger.”
According to Miller, the new approach is the result of collaboration between engineers and clinicians, and it incorporates online and simulation technologies.Simulation-based training is used to teach standardized ultrasound-guided internal jugular central venous catheterization (US-IJCVC), a procedure that involves placing a central line into the internal jugular vein through the neck.
Residents begin with online training, which includes tests before and after to assess their new knowledge. They then apply this knowledge in a skills lab, where they practice placing the central line on a dynamic haptic robotic trainer that can simulate different conditions and reactions. The residents can use ultrasound to visualize the line placement, just as they would on a real person, on the robotic trainer.c trainer, which provides automated feedback.
“We initially worked with 25 surgical residents at the Penn State Health Milton S. Hershey Medical Center, and then expanded to include all of the residents at Hershey. We also partnered with Cedars-Sinai Medical Center in Los Angeles to bring the training to their residents,” Miller explained. “In total, we have trained about 700 physicians to date, and we are currently training around 200 physicians per year with our current funding.”
According to Miller, it seems that practice can bring physicians closer to perfection without putting human lives at risk. In this study, Miller and her team compared error rates from 2022, which was the first year the simulation training occurred.The study looked at data from 2016 and 2017 when the training was not fully implemented, and did not include data from 2018-21 due to ongoing adjustments and challenges related to COVID. The researchers found that reported error rates for mechanical complications increased from 10.4% in 2016 to 12.4% in 2017, but dropped to 7.3% in 2022. Similarly, error rates related to infections increased from 6.6% in 2016 to 7.6% in 2017 and then decreased.The error rates for wrong-site surgeries dropped from 4.3% in 2016 to 3.7% in 2017, falling to 4.1% in 2022. As for blood clots, the mistake rates went from 12.3% in 2016 to 11.4% in 2017 and further decreased to 8.1% in 2022.
“We are encouraged by the outcomes and are committed to enhancing the system and potentially implementing it in other medical facilities,” Miller expressed. “We are making considerable progress in reducing error rates, but our goal is perfection. We strive for zero errors.”
Miller is also associated with the School of Engineering Design at Penn State College of Engineering, the College of Information Sciences and Technology, and the Department of Surgery at Penn State College of Medicine. Co-authors of the paper include Jessica M. Gonzalez-Vargas, a postdoctoral scholar.The research was conducted by Jessica M. Gonzalez-Vargas, a graduate student in industrial engineering at Penn State; Elizabeth Sinz, who is the associate medical director of the West Virginia University Critical Care and Trauma Institute; and Jason Moore, a professor of mechanical engineering at Penn State.
Funding for this research was provided by the U.S. National Science Foundation and the National Institutes of Health’s National Heart, Lung, and Blood Institute.