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Research article
Program on high value cost-conscious education in Intensive Care:
Educational program on prediction of outcome and cost awareness on Intensive Care admission
Linda van Wagenberg
Universitair Medisch Centrum Utrecht
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0702-6265
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Intensive Care (ICU) involves extended and long lasting support of vital functions and organs. However, current training programs of ICU residents mainly focus on extended support of vital functions and barely involve training on cost-awareness and outcome. We incorporated an educational program on high-value cost-conscious care for residents and fellows on our ICU and measured the effect of education.
Methods: A cohort study with factorial survey design, in which ICU residents and fellows were asked to evaluate clinical vignettes, was performed on the mixed surgical-medical ICU of the Amsterdam University Medical Centre. Residents were offered an educational program focusing on outcome and costs of ICU care. Before and after the program they filled out a questionnaire, which consisted of 23 vignettes, in which known predictors of outcome of community acquired pneumonia (CAP), pancreatitis, acute respiratory distress syndrome (ARDS) and cardiac arrest were presented, together with varying patient factors (age, body mass index (BMI), acute kidney failure (AKI) and haemato-oncological malignancy). Participants were asked to either admit the patient or estimate mortality.
Results: BMI, haemato-oncological malignancy and severity of pancreatitis were discriminative for admission to ICU in clinical vignettes on pancreatitis and CAP. After education, only severity of pancreatitis was judged as discriminative. Before the intervention only location of cardiac arrest (in- vs out of hospital) was distinctive for mortality, afterwards this changed to presence of haemato-oncological malignancy.
Conclusion: We incorporated an educational program on high-value cost-conscious care in the training of ICU physicians. Based on our vignette study, we conclude that the improvement of knowledge of costs and prognosis after this program was limited.
Keywords
High-value cost-conscious care, post-graduate education, curriculum development, evaluation of education
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Editorial decision: Minor revision
On 02 May, 2020
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Received 10 Feb, 2020
Reviewer #1 agreed
On 06 Feb, 2020
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On 06 Feb, 2020
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Invitations sent on 24 Jan, 2020
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Editor invited
On 22 Jan, 2020
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Editor assigned
On 06 Jan, 2020
Editorial decision: Revise before sending to peer reviewers
On 06 Jan, 2020
Submission checks complete
On 31 Dec, 2019
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On 31 Dec, 2019
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On 25 Dec, 2019
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This preprint is under consideration at BMC Medical Education. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Program on high value cost-conscious education in Intensive Care:
Educational program on prediction of outcome and cost awareness on Intensive Care admission
Linda van Wagenberg
Universitair Medisch Centrum Utrecht
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0702-6265
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 30 May, 2020
No community comments so far
Editor assigned
On 21 May, 2020
Submission checks complete
On 20 May, 2020
Editor invited
On 20 May, 2020
No comments provided
Review #2 received
Received 02 May, 2020
Editorial decision: Minor revision
On 02 May, 2020
Review #1 received
Received 10 Feb, 2020
Reviewer #1 agreed
On 06 Feb, 2020
Reviewer #2 agreed
On 06 Feb, 2020
Reviewers invited
Invitations sent on 24 Jan, 2020
Editor assigned
On 23 Jan, 2020
Submission checks complete
On 22 Jan, 2020
Editor invited
On 22 Jan, 2020
No comments provided
Editor assigned
On 06 Jan, 2020
Editorial decision: Revise before sending to peer reviewers
On 06 Jan, 2020
Submission checks complete
On 31 Dec, 2019
Editor invited
On 31 Dec, 2019
First submitted
On 25 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Intensive Care (ICU) involves extended and long lasting support of vital functions and organs. However, current training programs of ICU residents mainly focus on extended support of vital functions and barely involve training on cost-awareness and outcome. We incorporated an educational program on high-value cost-conscious care for residents and fellows on our ICU and measured the effect of education.
Methods: A cohort study with factorial survey design, in which ICU residents and fellows were asked to evaluate clinical vignettes, was performed on the mixed surgical-medical ICU of the Amsterdam University Medical Centre. Residents were offered an educational program focusing on outcome and costs of ICU care. Before and after the program they filled out a questionnaire, which consisted of 23 vignettes, in which known predictors of outcome of community acquired pneumonia (CAP), pancreatitis, acute respiratory distress syndrome (ARDS) and cardiac arrest were presented, together with varying patient factors (age, body mass index (BMI), acute kidney failure (AKI) and haemato-oncological malignancy). Participants were asked to either admit the patient or estimate mortality.
Results: BMI, haemato-oncological malignancy and severity of pancreatitis were discriminative for admission to ICU in clinical vignettes on pancreatitis and CAP. After education, only severity of pancreatitis was judged as discriminative. Before the intervention only location of cardiac arrest (in- vs out of hospital) was distinctive for mortality, afterwards this changed to presence of haemato-oncological malignancy.
Conclusion: We incorporated an educational program on high-value cost-conscious care in the training of ICU physicians. Based on our vignette study, we conclude that the improvement of knowledge of costs and prognosis after this program was limited.
Figure 1