Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Maintaining competence in high-acuity, low-occurrence (HALO) procedures poses a challenge for emergency physicians as they progress past residency training or practice in lower-acuity settings. Simulation-based deliberate practice offers a feasible method to sustain procedural competence. We developed and evaluated a blended, faculty development procedural curriculum designed to improve confidence and clinical application of HALO skills across a five-hospital emergency medicine (EM) network.

Methods: A faculty needs assessment and departmental quality data informed the creation of a 4-hour procedural curriculum course. The blended curriculum included asynchronous precourse procedural guides and videos followed by a 4-hour, in-person deliberate practice session led by peer EM faculty instructors. Year one procedures included cricothyroidotomy, transvenous pacing, catheter thoracostomy, neonatal resuscitation, and peritonsillar abscess drainage. Year two curriculum included fiberoptic nasotracheal intubation, pediatric airway management, ultrasound-guided pericardiocentesis, intraosseous access, lateral canthotomy, balloon tamponade of gastrointestinal hemorrhage, fascia iliaca nerve block, and orthopedic reduction/splinting. All stations used clinical equipment stocked across the enterprise. Anonymous pre- and post-course surveys measured self-reported procedural confidence and global course satisfaction. Procedure billing data and faculty self-report were used to evaluate clinical application.

Results: In year one, 62 of 90 (69%) participants completed surveys which demonstrated significant increases in confidence across all procedures (P < .01) with high satisfaction (median 5, IQR 5-5). Year two results were similar: 67 of 87 (77%) completed surveys, again showing significant confidence gains (P < .01) and high satisfaction (median 5, IQR 5–5). Seventy percent (47 of 67) of year two respondents were returning participants; among them, 68% reported performing at least one procedure reviewed in year one. All reported increased confidence during clinical performance. Peritonsillar abscess drainage increased from 14 procedures precourse to 133 in year one and 83 in year two, with 35% performed in regional hospitals. We observed no change in procedure-related quality incidents.

Conclusion: Our faculty procedural curriculum offers a framework that emergency departments can use to support faculty in increasing confidence in performing HALO and other low-frequency procedures. Future research should evaluate the durability of this educational approach, including how long the intervention preserves procedural confidence without decay.