The effect of a heart failure training intervention assessed via clinical simulation

Abstract

Prehospital differential diagnosis of heart failure (HF) by paramedics is sometimes unreliable (Schaider et al, 1995) and may lead to therapeutic interventions being withheld (Jenkinson et al, 2008) or the initiation of inappropriate and potentially harmful treatment (Wuerz and Meador, 1992). To date, no studies have evaluated the effect of participation in a HF training intervention on diagnostic accuracy among undergraduate UK paramedics assessed through clinical simulation. In this study, 17 paramedics were exposed to three mannequin based scenarios designed to simulate HF, pneumonia and chronic obstructive pulmonary disease (COPD). Participants were given up to 10 minutes to examine each mannequin and scrutinize clinical data before recording a diagnosis. Participant demographics and self reported confidence relating to assessment and management of HF were collected via a questionnaire. Two weeks later, participants attended a 90 minute targeted HF training intervention. Two weeks post training, the paramedics repeated the clinical simulation exercise and questionnaire. Initial diagnostic sensitivity and specificity for HF were higher than that reported in a previous UK clinical study, and improved following participation in a training intervention, although this failed to reach significance (83% vs 100% and 91.67 vs 100%, P>0.05). A significant improvement in self reported confidence relating to use of ECG findings in assessment of HF patients was noted (z=-2.309, P=0.021). In this study, paramedic differential diagnosis of HF assessed through clinical simulation demonstrated a non-significant trend towards improved sensitivity and specificity following participation in a targeted training intervention.