UT Southwestern Standardization of IJ CVC Insertion Across Multiple Specialties

BACKGROUND: Standardization of procedures decreases patient complications and improves patient care. University of Texas Southwestern(UTSW) Medical Center is a large academic institution that fosters/trains physicians from all over the country and world. The diversity of physician background in specialties and clinical interests leads to a large variation for the teaching and insertion of internal jugular(IJ) central venous catheters (CVC). In order to improve clinical training of residents and decrease patient harm, the standardization of IJ CVC insertion was undertaken at UTSW. OBJECTIVE: Standardize IJ CVC Insertion Across All Specialties at UTSW METHODS: Stakeholders were identified at the project's inception for proper sponsorship and support. Consensus across multiple specialties was achieved using a modified Delphi method. Process Map was generated using previously identified standards of practice1,2,3 for CVC insertion and modified for implementation according to resources specific to UTSW hospital system. UTSW Checklist was created based on expert consensus and the UTSW process map that included elements from work done by other academic institutions4-12. Education resources were created tailored to the UTSW process map in order to create a simulation training for future physicians and residents at UTSW. Training Video and exams were created to measure learner's competency/retention of UTSW IJ CVC insertion. RESULTS: Consensus for one method of IJ CVC insertion across multiple specialties was achieved. Checklist, educator manual, learner manual, and video were created specific to UTSW CVC insertion method. Simulation training of UTSW Physicians was begun on March 19, 2018. CONCLUSION: Creation of the UTSW IJ CVC insertion method and a simulation curriculum to teach residents/physicians was successful. Future work could be collected on hospital complications rates associated with CVC insertion and comparing the complications of 2018-2019 year to prior 2017-2018 year. Residents can be followed at 6 months intervals out of simulation training to determine retention and mastery of skill.