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2015 HSR&D/QUERI National Conference Abstract

1151 — Critical Care Education Needs at Rural VA Intensive Care Units

Moeckli J, Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System; Stanke S, Central VA ICU Telemedicine System, Minneapolis VA Health Care System; Clutter K, Central VA ICU Telemedicine System, Minneapolis VA Health Care System;

Although essential to high quality care in intensive care units (ICUs), little is known about the state of existing critical care education in VHA, particularly in rural hospitals. In this operations-partnered project, we used rapid qualitative assessment to better understand rural ICUs' critical care education needs, as well as contextual factors that may impact participation in education activities.

We conducted outreach to six rural ICUs in two VISNs served by the Central VA ICU Telemedicine System (CVAICUTS) between April and June 2014. A total of 64 staff, including ICU managers, nurses, facility educators and simulation coordinators, discussed the development of a distance learning program with the CVAICUTS educator and project lead. Detailed fieldnotes of outreach events were recorded then summarized in a standardized template. A two-stage rapid qualitative assessment was used to generate actionable preliminary findings: 1) facilitated debriefing, and 2) a matrix analysis.

We identified three findings that shaped the development of the distance learning program: 1) Only one of six facilities had a critical care educator, with most educational tasks addressed by ICU nurse managers or ICU nurses. Despite limited resources, nurses want professionally relevant education, especially curriculum designed to increase confidence in infrequent interventions. 2) Distance learning modalities were acceptable but not sufficient: ICUs were concerned that distance learning may not be sensitive to site-specific needs, and wanted encounters with other rural ICUs to build connections based on common experiences. 3) Simulation at varying levels of fidelity was identified as useful, but was underutilized at most sites due to organizational barriers.

Rural ICUs have a need for critical care education, and simulation is well-suited to address high risk-low frequency interventions. The power of shared experience was an underlying factor that could mediate engagement with the proposed distance learning program; ICUs were apprehensive about the applicability of a general critical care program to their site, and wanted a space to connect and learn from rural ICUs like their own.

Distance learning programs delivering critical care education to rural ICUs will require innovative design and local support to facilitate networked simulations and staff connection.