Background Prehospital diagnosis of Heart Failure (HF) by paramedics is sometimes unreliable and may lead to therapeutic interventions being unintentionally withheld, or the initiation of inappropriate and potentially harmful treatment. To date, no studies have evaluated the effect of participation in a training intervention in relation to HF amongst undergraduate UK paramedics.
Study objectives To evaluate baseline diagnostic accuracy and the effect of participation in a targeted HF training intervention on diagnostic accuracy amongst undergraduate paramedics assessed through medical simulation.
Methods Participants completed a questionnaire to assess self reported confidence via Likert scale responses to a range of statements relating to various aspects of assessment and management of HF patients, before assessing and recording a diagnosis for three simulated patients with breathlessness. Scenarios were developed to simulate HF, chronic obstructive pulmonary disease (COPD) and pneumonia. Two weeks after the initial simulation, participants attended a 90 min targeted training intervention. A further 2 weeks later, participants repeated the questionnaire and simulation session.
Results Initial sensitivity and specificity for HF were 83% and 91.67%. Both improved to 100% after participation in targeted HF training. Changes in diagnostic accuracy were not statistically significant. No statistically significant differences in pre and post intervention Likert scale responses were noted, with the exception of responses regarding use of 12 lead ECG findings (z=−2.309, p=0.021).
Conclusion A non-significant trend towards increased diagnostic sensitivity and specificity for HF was observed following the second phase of simulation, although the absence of a control group in this study limits the extent to which this effect can be attributed to the training intervention. Results suggest that significant benefits could be realised for HF patients with more widespread use of targeted training interventions and access to medical simulation facilities. Further research incorporating a control group and a larger, more heterogenous sample is warranted.
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