Right heart catheterization blended training program: quality improvement and educational outcomes

Accurate measurement and reporting of pulmonary arterial wedge pressure (PAWP) and cardiac output (CO) are essential for diagnosing and managing pulmonary hypertension and pulmonary arterial hypertension (PAH). Errors in these parameters can lead to misclassification and inappropriate treatment. Recent updates from the 2023 European Respiratory Society/European Society of Cardiology guidelines and the 2024 Seventh World Symposium on Pulmonary Hypertension emphasize the need for standardized right heart catheterization (RHC) practices.

To identify knowledge gaps in RHC practices among interprofessional team members and implement a targeted blended learning program developed for pulmonary critical care and cardiology fellows, with a focus on accurate acquisition and interpretation of PAWP and CO.

Using the SQUIRE framework, we conducted a baseline survey assessing RHC practices and knowledge among pulmonary critical care and cardiology attending physicians and fellows and critical care nurses at an academic medical center. Respondents were actively involved in RHC procedures across the cardiac catheterization laboratory, medical intensive care unit, and cardiac care unit. Survey items with < 70% correct response were used to guide development of a 120-minute blended learning program incorporating lectures, video instruction, and hands-on-simulation. Pre- and posttraining assessments were conducted.

Of 141 invited participants, 85 responded to the survey (60.3% response rate). Baseline data revealed knowledge gaps and therefore opportunities for learning in CO measurement methods and PAWP interpretation. Assessment postblended learning program demonstrated knowledge improvements in key areas including identification of indirect Fick (iFick) as the most common CO method, confirmation of zero-reference level by the proceduralist-nurse team, acquisition of PAWP, and obtaining at least 3 measurements of CO via thermodilution. However, correct identification of end-expiratory PAWP declined, highlighting the need for greater emphasis on this skill in future training sessions.

This is the first reported interprofessional training initiative to target CO and PAWP measurement accuracy in RHC. This study identified key knowledge gaps and therefore opportunities for learning. Knowledge improvements measured after the educational intervention support the need for ongoing, structured, and interprofessional training to enhance procedural competency and interpretation of RHC hemodynamic data to optimize pulmonary hypertension and PAH care.