Improving the cost-effectiveness of laypersons' paediatric basic life support skills training: A randomised non-inferiority study

Asbjørn Hasselager; Cathrine Bohnstedt; Doris Østergaard; Claus Sønderskov; Kristine Bihrmann; Martin G Tolsgaard; Torsten L B Lauritsen

doi:10.1016/j.resuscitation.2019.02.032

Improving the cost-effectiveness of laypersons' paediatric basic life support skills training: A randomised non-inferiority study

Resuscitation. 2019 May:138:28-35. doi: 10.1016/j.resuscitation.2019.02.032. Epub 2019 Mar 2.

Authors

Asbjørn Hasselager¹, Cathrine Bohnstedt², Doris Østergaard³, Claus Sønderskov⁴, Kristine Bihrmann⁵, Martin G Tolsgaard³, Torsten L B Lauritsen⁶

Affiliations

¹ University of Copenhagen, Copenhagen Academy for Medical Education and Simulation (CAMES), RegionH, Denmark. Electronic address: ahasselager@dadlnet.dk.
² Department of Pediatrics, North Zealand Hospital, Denmark.
³ University of Copenhagen, Copenhagen Academy for Medical Education and Simulation (CAMES), RegionH, Denmark.
⁴ RedMitBarn - Firstaiders, Frederiksberg, Denmark.
⁵ National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
⁶ Department of Anaesthesia, The Juliane Marie Centre, Rigshospitalet University Hospital, Copenhagen, Denmark.

PMID: 30836169
DOI: 10.1016/j.resuscitation.2019.02.032

Abstract

Aim: To compare dyad (training in pairs without an instructor) with resource-intensive instructor-led training for laypersons' paediatric resuscitation skills in a non-inferiority trial and examine cost-effectiveness of the training methods.

Methods: In this randomised parallel group non-inferiority trial, 155 dyad and 175 instructor-led laypersons were trained in Basic Life Support and Foreign Body Airway Obstruction Management. Dyads were given instructional videos, hands-on exercises and provided feedback to their partner for 50 min. Instructor-led laypersons trained in groups of six for two hours. Learning were assessed in scenarios immediately after training and, subsequently, at 14 days, 1, and 3 months. Pass rates, cost-effectiveness of producing a competent layperson (passing both tests), and non-inferiority were analysed.

Results: Sixty-eight (45.6%) dyad and 130 (74.3%) instructor-led laypersons passed the basic life support test (p < 0.001). For Foreign Body Airway Obstruction Management 77 (54.2%) dyad and 130 (79.3%) for instructor-led laypersons passed (p < 0.001). Skills decreased over three months for both groups. Forty-two (30.4%) dyad and ninety-eight (59.8%) for instructor-led laypersons were competent after training (p < 0.001). The lower effectiveness of dyad training had reduced costs (p < 0.001). For each 10,000 USD allocated to training, dyad training would result in 71 vs. 65 competent laypersons for instructor-led training. Non-inferiority of dyad training could not be established.

Conclusion: Instructor-led training was the most effective but also the most expensive training method, making it less cost-effective than dyad training. When the aim is to train for quantity rather than quality, dyad training would be the preferred choice of training method.

Keywords: Basic life support; Cost-effectiveness; Dyad training; Education; Foreign body airway obstruction; Hands-on; Heart-lung rescue; Hlr; Laypeople; Layperson; Manikin training; Paediatric Basic Life Support; Pairs; Peer training; Simulation; Training.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Airway Obstruction / etiology
Airway Obstruction / therapy*
Child
Cost-Benefit Analysis
Education, Nonprofessional* / economics
Education, Nonprofessional* / methods
Educational Measurement
Female
Foreign Bodies / complications*
Health Knowledge, Attitudes, Practice
Humans
Male
Out-of-Hospital Cardiac Arrest / therapy*
Pediatrics / methods
Resuscitation* / education
Resuscitation* / methods
Teaching* / classification
Teaching* / standards