Penn State researchers have spent more than a decade making central line placement safer for patients. Central lines are among the most common hospital procedures, and among the first a new resident performs, but they carry a high risk of complications. The team's system, which gives trainees real-time feedback as they practice through a combination of advanced sensors and personalized training, has reduced central line medical errors by up to 46%. Now, a $3.7 million, five-year grant from the National Institutes of Health's (NIH) National Heart, Lung, and Blood Institute will allow the researchers to expand the system and further reduce complications, infections and other injuries for patients receiving central lines.
Scarlett Miller, Paul Morrow Professor of Engineering Design and Manufacturing and the Advance Realty Investors Director of the Cocoziello Institute of Real Estate Innovation, and Jason Moore, professor of mechanical engineering, will lead the newly funded project in collaboration with their clinical partners Sanjib Adhikary, professor of anesthesiology and perioperative medicine at the Penn State College of Medicine; Philip Ng, professor of medicine, and Tanya Bhardwaj, assistant professor of medicine, both at Cedars-Sinai Medical Center in Los Angeles; and Elizabeth "Lisa" Sinz, professor of anesthesiology at the West Virginia University School of Medicine. Jessica González-Vargas, assistant professor of industrial and systems engineering at Mississippi State University, is also a collaborator on the project. She joined the research as a doctoral student and continued as a postdoctoral scholar before joining the Mississippi State faculty.
"The reality is that every resident has to place a line on their first central line on a real patient," Miller said. "Our goal is to make sure they're ready when they do. We've made real progress with our clinical partners over the past decade, and we'll keep going until preventable errors are no longer part of the picture."
Miller and Moore work with a broad range of clinicians to understand common problems and work to develop solutions that include physician insights about the underlying systems that impact training models. One of the major problems they first learned about was the high error rate with central line placements. Central line placement is one of the most common invasive procedures performed in hospitals, with many critically ill and hospitalized patients requiring a central line during their care. Traditionally, residents have learned the procedure in part by performing it on actual patients. By developing a realistic central line placement training system, residents could build the skills needed to place lines - with fewer errors and complications - in real patients.
"Over the last decade, we have trained over 1,000 medical residents," Moore said. Their system, which can withstand repeated trainings, uses novel technology to simulate patients for students and trainees to practice how to place central lines in a variety of physical and temperamentally different people. "With this new grant, we are aiming to make the training even better-more realistic, more personalized, and better able to prepare clinicians for the different situations they'll face with real patients."
A crucial part of the research and development, the researchers said, has been and will continue to be working with physicians across all avenues of healthcare to gather as many perspectives as possible.
"Our research directly impacts medical residents," Miller said. "Partnering institutions already recognize the importance of training residents, monitoring these procedures and modifying the process when needed. They know the problems, and we want them to be collaborators as we help develop solutions."
Clinical partner Sanjib Adhikary, director of Acute Pain, Regional Anesthesia and Orthopaedics for Penn State Health, said the collaboration has developed into "one of the most meaningful interdisciplinary partnerships" of his career.
"This partnership has allowed us to identify problems directly from patient care and medical education, develop engineering solutions, and then bring those technologies back into the clinical setting for evaluation and implementation," Adhikary said.
Ng of Cedars-Sinai Medical Center said his partnership with Miller and Moore has offered meaningful new perspectives to his work.
"I have worked across many departments, but never with engineers [before this partnership]," Ng said. "They approach issues from a different vantage point and have broadened my perspectives."
The research supported by the prior NIH grant has also led to four U.S. patents, which Penn State has licensed to Medulate, a Penn State startup bringing the training system to hospitals beyond the lab. Medulate recently won the technology competition at the Invent Penn State Venture and IP Conference.
The new five-year grant will build on that foundation by adding a development called Resident Artificial Intelligence Skills Education, or RAISE, to the training system. The researchers said this builds on the initial research training to incorporate more clinical decision-making, error management and real-time tracking of steps and procedures. The goal is to not just examine the mechanical performance of skills, but also the cognition and human decision-making of the training process.
"Through this grant, we are developing an enhanced training system that improves several aspects of the learning experience," Moore said, explaining it will be a high-fidelity system, which means it will establish a realistic feeling and visual experience for training. It will also have automated feedback that provides highly accurate quantitative information about user performance. "The goal is to capture some of what an expert instructor does during traditional hospital-based manikin training - observing performance, identifying mistakes and providing feedback - but to do it in a consistent, automatic, and objective way."
The researchers are also developing more diverse training scenarios that present a variety of body types and anatomies to better equip medical residents for real-world patients in the clinic.
"One of my favorite aspects of this line of research is our ability to play at the intersection of physical and digital design aspects of medical tools" Miller said. "We're exploring how sensors, advanced materials, artificial intelligence and augmented reality can come together to create medical training programs that feel more realistic, provide meaningful feedback and ultimately better prepare clinicians for patient care.
Key to the process of making the training as realistic as possible is clinician involvement, the team emphasized.
"We integrate those clinical perspectives throughout the human-centered design process, and that collaboration has been critical to our work," Miller said. "We're proud of what we've developed together because it's grounded in real clinical needs and designed to address the challenges that directly impact so many people."
This work is done in collaboration with Cedars-Sinai Medical Center, West Virginia University and Penn State Health Milton S. Hershey Medical Center through the National Institutes of Health's National Heart, Lung, and Blood Institute under award number 2R01HL127316-09A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.
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