(1629) Implementing a Novel Tele-Simulation Septic Shock Training Program for Low-Resourced Settings

Introduction: Sepsis poses challenges in Low Resource Settings (LRS): delayed recognition and time-critical treatment. Outcome disparities are linked to lack of effective training. Our objective is to report baseline compliance with time-critical tasks for septic shock (oxygen, intravenous access (IV), fluid, and antibiotics in < 1 hour) in Ghana, and study implementation of a novel low-bandwidth tele-simulation septic shock training. We hypothesize that contextualized tele-simulation training will improve time-critical performance score for simulated septic shock cases.

Methods: Using a prospective quasi-experimental design, we obtained baseline real patient process of care and morbidity data for patients who arrived at Komfo Anokye Teaching Hospital with suspected sepsis, predefined by institutional screening criteria (SIRS and suspected infection). Trained observers recorded time-to-perform tasks during clinical encounters: assessment, shock recognition, oxygen, IV access, fluid bolus, reassessment, blood culture, antibiotics. Short tele-simulation sessions targeting time-critical tasks were conducted using a distance learning platform, with embedded Ghanaian patient video clips. Observers recorded completed tasks for each group; the total number of completed tasks was the performance score. We compared the scores between the first and second simulation sessions using Wilcoxon rank sum test.

Results: We enrolled 70 real patients during the pre-intervention phase, (age, year median 1.6 [IQR: 0.8-7.0]). 61% received oxygen (median initiation time from presentation, 1[IQR: 0–7.5] min); 75% had successful IV placements (49[25–100] min); 44% had IV bolus fluids (69[37.5–148.5] min); 37% were reassessed (207.5[62.5–264] min); 57% had blood cultures (93[33.5-305] min); 70% received antibiotics (160[120-265] min). In simulation there was a significant improvement of completion of task performance score between the first (median [IQR]:5 [4–6], n=11) and second training (8 [7–8], n=6), p = 0.013.

Conclusions: Baseline compliance with time-critical tasks (oxygen, IV access, fluid, antibiotics < 1 hr) for real patients presenting with septic shock in Ghana is poor. Contextualized low-bandwidth distance tele-simulation training significantly improved time-critical performance scores in simulated septic shock cases.