Improving the Ability of Novice Advanced Practice Clinicians and Students to Recognize Clinical Deterioration and a Need for Transferring Care

Background: Early identification of clinical deterioration and quickly transferring to a higher level of care are essential for decreasing in-hospital mortality and improving patient outcomes. Although there are support tools and guidelines to help recognize clinical deterioration, a gap remains as this continues to be one of the most challenging skills for novice Advanced Practice Clinicians (APCs) and Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) students. The current education model of Nurse Practitioner programs has resulted in inconsistencies in students' skill levels, resulting in poor relationships with preceptors and limited opportunities for clinical experiences. Even after licensure, there is no opportunity for novice APCs at Huntsman Cancer Institute to learn the early indicators of clinical deterioration or a need for transferring patients to a higher level of care. This project aimed to increase the ability of novice APCs and AGACNP students to recognize clinical deterioration and a need for transferring patients to a higher level of care through the development of an advanced simulation experience. Methods: This quality improvement (QI) project began with a needs assessment done by interviewing an experienced APC content expert to determine the baseline ability of novice APCs and AGACNP students to recognize clinical deterioration and a need for transferring patients. This interview and an evidence-based literature review identified the components needed for the simulation training. Writing the simulation script was based on national standards of practice, and individuals independent from the project attended a practice run. Participants completed a pre-intervention survey to determine baseline knowledge, usability, and acceptability before participating in the simulation experience. Participants then completed a post-intervention survey after the simulation experience to determine post-intervention knowledge and the feasibility of the training. Lastly, follow-up surveys were distributed to participants one month after the simulation to determine how participants utilized skills gained from the program in clinical practice. Results: Post-intervention, participants felt prepared to recognize the indicators of clinical deterioration (p=0.006712) and understood when to transfer the patients to a higher level of care (p=0.02965). All the participants (n=16) reported overall satisfaction with the simulation experience. 11 of the 16 participants cared for a patient with clinical deterioration following the advanced simulation, with 72.73% (n=8) reported having utilized knowledge gained from the experience when caring for the clinically deteriorating patient. 7 of the 16 participants cared for a patient requiring transfer to the ICU following the advanced simulation, with 67.67% (n=4) reported having utilized knowledge gained from the experience when caring for a patient requiring transfer to the ICU. Conclusions: This advanced simulation experience appears to be a valuable resource to improve the ability of novice APCs and AGACNP students to recognize clinical deterioration and a need for transferring patients to a higher level of care. The findings of this QI project support the literature that simulation is an effective educational tool. Replication of this project could address other research-to-practice gaps.