Abstract
Background: Obtaining vascular access during operating room (OR) emergencies presents significant challenges for anesthesia providers. Delays in establishing vascular access can postpone the delivery of life-saving medications, leading to catastrophic patient outcomes. This project aims to bridge the educational gap among anesthesia providers regarding emergency vascular access decision-making, with a specific focus on the effective use of I/O devices for faster and safer patient care, guided by a structured decision tree.
Local Problem: A significant educational gap exists at a fast-growing, high-acuity, community hospital concerning intraosseous vascular access (IOVA) among perioperative staff. Before this project, no in-person I/O vascular access training programs were available to anesthesia personnel at the facility, nor was a decision tree provided to guide I/O device use. Lack of education and skill with IOVA can lead to poor patient outcomes and increased morbidity and mortality during perioperative emergencies.
Methods: A literature review confirmed that I/O vascular access is faster, more cost-effective, and technically simpler than central venous catheter placement. Research also indicated that prioritizing I/O access during OR emergencies can improve patient outcomes. A needs assessment revealed a significant need for I/O access administration education among anesthesia providers. The quality improvement project involved a detailed training session covering I/O access techniques, considerations, and potential complications. A best-practice guideline decision tree for I/O use was placed in each OR near the anesthesia machine for sustained accessibility. The provider’s knowledge and confidence related to IOVA were assessed using pre- and post-training Qualtrics surveys. Providers' IOVA placement times were documented in a simulation and compared to a literature-reviewed average central venous catheter (CVC) placement time.
Interventions: Education and training were provided by experienced I/O users and clinical representatives from the device’s manufacturer, with whom the facility maintains an existing contract.
Results: Providers who received IOVA education, training, and simulation demonstrated enhanced knowledge, competence, and confidence. In addition, providers demonstrated reduced vascular access times when compared to CVC.
Conclusion: The implemented education session and readily available decision tree equip anesthesia providers with the necessary tools to safely improve patient outcomes by reducing time to life-saving vascular access. Limitations include variations in providers' prior I/O access knowledge and experience, potential resistance to education, and the inability to directly assess the impact of the training in actual patient care scenarios. Future research may include simulation-based training and evaluation of I/O use in actual emergencies.