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Online simulated patient cases may improve care, reduce costs in sepsis and heart failure
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Hospitalists who participated in online training cases for sepsis and heart failure provided improved care to their patients, resulting in reduced hospital stays and significant cost savings, according to a study published in the Journal of Hospital Medicine.
“Sepsis and heart failure are two common, costly and deadly conditions,” Michael Yurso, MD, of AdventHealth in Florida, and colleagues wrote. “Previous research shows that evidence-based care decisions can impact the outcomes for these patients. However, rapid dissemination and adoption of evidence-based guidelines remain a challenge. [We used a] validated, simulation-based measurement and feedback approach to engage hospitalists and standardize evidence-based practices for patients with sepsis and heart failure. We documented specific areas of variation identified in the simulation, how those practices changed through serial feedback, and the impact of those changes on real-world outcomes and costs.”
Researchers compared the performance of 58 hospitalists who used simulated patient cases with 96 who did not. Administered online, the cases simulated a typical clinical encounter including taking a medical history, performing a physical examination, ordering tests, making a diagnosis, implementing initial treatment and outlining a follow-up plan. Participants received personalized online feedback reports on care decisions and had group discussions about areas of variation after each round of case simulations (two cases per round; six rounds total).
The primary outcomes of the study were general performance improvements (scored against evidence-based scoring criteria), disease-specific improvements and changes in patient-level outcomes and economic savings.
Researchers found that, over 2 years, the performance scores of hospitalists who participated in the simulated cases improved by 8%, specifically in the utilization of 3-hour sepsis bundles and ordering essential medical treatment elements for heart failure.
In addition, in the first year, the average length of stay rates declined 8% for simulated patients compared with a decline of 2.5% for patients treated in hospitals without the simulation tool (570 hospital days saved).
Finally, researchers calculated a total cost savings of $6.2 million due to these improvements.
“With continued consolidation in health care and broader health systems spanning multiple geographies, new tools are needed to support standardized, evidence-based care across sites,” the researchers wrote. “However, changing practice cannot happen without collaborative engagement with providers. Standardized patient vignettes are an opportunity to measure and provide feedback in a systematic way that engages providers and is particularly well-suited to large systems and common clinical conditions.” – by Melissa J. Webb
Disclosures: The study was funded by AdventHealth and QURE LLC. The authors report no other relevant financial disclosures.