A Quality Improvement Initiative: A Provider Education Simulation For Management And Treatment Of Local Anesthetic Systemic Toxicity Protocol

Abstract

Local Anesthetic Systemic Toxicity (LAST) is a rare, life-threatening complication of regional anesthesia that can cause severe neurological and cardiovascular collapse. Due to its low clinical incidence, a significant practice gap exists; perioperative providers frequently lack the knowledge and confidence to recognize and treat it efficiently. This quality improvement project evaluated whether a high-fidelity educational video simulation, paired with evidence-based cognitive aids, improves perioperative staff knowledge and confidence compared to traditional educational protocols. Guided by the Johns Hopkins Nursing Evidence-Based Practice Model and a Plan-Do-Study-Act framework, a quantitative, quasi-experimental pre-test/post-test design was implemented at Corewell Health Beaumont Grosse Pointe Hospital. Perioperative nursing staff completed identical baseline and post-intervention assessments evaluating objective clinical knowledge (12-item quiz) and self-reported confidence (13- item, 5-point Likert scale). Participants viewed a targeted LAST video simulation filmed at the Eugene Applebaum Simulation Center that incorporated the American Society of Regional Anesthesia and Pain Medicine (ASRA) checklist. Data from the independent cohorts (n=24 pre-intervention; n=16 post- intervention) were analyzed using independent samples t-tests.The intervention yielded a statistically significant improvement in objective knowledge scores (p ≤ 0.05), with the mean score rising from 8.5 (SD = 1.14) pre-intervention to 10.6 (SD = 1.20) post-intervention, demonstrating a large effect size (Cohen’s d = 1.8). Self-reported clinical confidence also significantly elevated (p ≤ 0.05), nearly doubling from a pre-intervention mean of 27.4 (SD = 3.90) to a post-intervention mean of 47.6 (SD = 2.45). Integrating immersive video simulations with standardized cognitive aids effectively translates complex crisis protocols into retainable knowledge while mitigating clinical hesitation in high-acuity emergencies. Despite limitations like sample size attrition and a single-center design, this project establishes a scalable, low-cost blueprint for high-risk, low-frequency event readiness. Incorporating this simulation tool into onboarding curriculum and annual competencies is recommended to sustain emergency preparedness and maximize patient safety.