160 - Implementation of Large-Scale Nurse Training on Shock Recognition Leveraging Multi-User Immersive Virtual Reality

Publication Number: 4157.160

Matthew Zackoff, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jacob T. Fleck, Cincinnati Children's Hospital Medical Center, CINCINNATI, OH, United States; Kelly Collins, Cincinnati Childrens Hospital, Alexandria, KY, United States; Kyesha James, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Andrea Meisman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Kelly Ely, Cincinnati Children's Hospital Medical Center, Loveland, OH, United States; John R. Forbes, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Amy Mattingly, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Rashmi D. Sahay, Children's Hospital & Medical Center, Cincinnati, OH, United States; Bin Zhang, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer Saupe, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Melissa Kimball, Cincinnati Children's Hospital Medical Center, Hamilton, OH, United States; Beth Mayer, Cincinnati Children's Hospital Medical Center, West Harrison, IN, United States; Aimee B. Gardner, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Maya Dewan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Francis Real, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Pediatric sepsis is a leading cause of mortality worldwide. Despite efforts to standardize care processes and algorithms to enable prompt treatment, missed or delayed sepsis and shock management remains a challenge. Strategies are limited by insufficient situation awareness (SA) among front line staff to recognize sepsis/shock cues, interpret clinical relevance, and escalate care.

Objective: To address this gap, we implemented a multi-user immersive virtual reality training on shock recognition and management (MUVR_Shock) into new nurse orientation and evaluated the intervention via a prospective effectiveness-implementation hybrid type 1 trial.

Design/Methods: In the simulation, groups of 4-5 participants assessed a patient with septic shock with core learning objectives reinforced by a trained simulation facilitator (Figure 1). Clinical outcomes were captured for 18 months pre and post implementation while self-reported confidence and implementation items were assessed through post-training surveys and video review (Table 1). Effectiveness outcomes were analyzed pre-to-post curriculum via paired t-tests and via SPC charts while implementation metrics were analyzed with descriptive statistics. The IRB determined the study to be exempt/approved.

Results: MUVR_Shock was implemented from June 2023-Nov 2024. A total of 463 nurses completed the training, and 75.8% (n=351) completed the research survey. There were no serious safety events attributed to missed or delayed recognition of shock post implementation as compared to 2 pre-implementation. Self-reported comfort in verbalizing a concern for shock increased (Mean 3.79 pre to 4.28 post, p< 0.001). Participants indicated a high level of agreement with items measuring acceptability and appropriateness, but reported less than average usability (Figure 2 a,b,d) and mixed findings for feasibility (Figure 2c) that were primarily driven by technical challenges. Fidelity was mixed, and the primary persistent cost driver for implementation was facilitation personnel, with a one-time investment in VR equipment.

Conclusion(s): A multi-user VR training curriculum for pediatric sepsis/shock was successfully implemented and was associated with a reduction in serious safety events related to sepsis and an increase in self-perceived comfort in verbalizing a concern for shock. The curriculum had substantial reach with largely favorable acceptability, appropriateness, and fidelity; however, technical limitations of this initial research version of MUVR_Shock led to lower-than-average usability and mixed feasibility, informing future iterations of this novel training approach.

Figure 1: Participant View within MUVR_Shock


Table 1: Implementation Outcomes and Captured Metrics


Figure 2: Acceptability (a), Appropriateness (b), Feasibility (c), and Usability (d)