Background Determining when to entrust trainees to perform procedures is fundamental to patient safety and competency development.
Objective To determine whether simulation-based readiness assessments of first year residents immediately prior to their first supervised infant lumbar punctures (LPs) are associated with success.
Methods This prospective cohort study enrolled paediatric and other first year residents who perform LPs at 35 academic hospitals from 2012 to 2014. Within a standardised LP curriculum, a validated 4-point readiness assessment of first year residents was required immediately prior to their first supervised LP. A score ≥3 was required for residents to perform the LP. The proportion of successful LPs (<1000 red blood cells on first attempt) was determined. Process measures included success on any attempt, number of attempts, analgesia usage and use of the early stylet removal technique.
Results We analysed 726 LPs reported from 1722 residents (42%). Of the 432 who underwent readiness assessments, 174 (40%, 95% CI 36% to 45%) successfully performed their first LP. Those who were not assessed succeeded in 103/294 (35%, 95% CI 30% to 41%) LPs. Assessed participants reported more frequent direct attending supervision of the LP (diff 16%; 95% CI 8% to 22%), greater use of topical analgesia (diff 6%; 95% CI 1% to 12%) and greater use of the early stylet removal technique (diff 11%; 95% CI 4% to 19%) but no difference in number of attempts or overall procedural success.
Conclusions Simulation-based readiness assessments performed in a point-of-care fashion were associated with several desirable behaviours but were not associated with greater clinical success with LP.
- patient safety
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Contributors DOK is primarily responsible for the conception and design of the study, drafting of the article and contributed to analysis and interpretation of data. TPC, MA, DMF, MEL, JT, MOL, JMG and DG were site directors primarily responsible for overseeing local data collection and study implementation. They all contributed meaningfully to study design, critically revising the manuscript and approved the final manuscript as submitted. MP and TW were primarily responsible for data analysis and interpretation. They were involved in aspects of study design, drafting and critical revision of the manuscript and approved the final version as submitted.
Funding All phases of this study were supported by a non-profit foundation grant (principal investigator: DOK) provided by the R Baby foundation.
Competing interests None declared.
Ethics approval Columbia University was primary, but all sites had their own local approval.
Provenance and peer review Not commissioned; externally peer reviewed.
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