Decision making in trauma settings: simulation to improve diagnostic skills.
Decision making in trauma settings: simulation to improve diagnostic skills.
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创伤环境中的决策：模拟以提高诊断技能。
DOI：
10.1097/sih.0000000000000073
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
Klingensmith,MaryE
中科院分区：
文献类型：
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作者：
Murray,DavidJ;Freeman,BradD;Boulet,JohnR;Woodhouse,Julie;Fehr,JamesJ;Klingensmith,MaryE
方法制定了10个情景来评估创伤小组为严重受伤患者提供初始护理的能力。七个标准场景模拟了严重损伤，一旦诊断出来，可以使用标准的高级创伤生命支持算法有效治疗。由于诊断错误在复杂的临床环境中更常见，因此复杂的情况需要团队使用更先进的诊断技能来发现共存的疾病并对患者进行治疗。由3到5名实践者组成的团队在7个（10个）随机选择的场景（5个标准，2个复杂）的表现中进行评估。专家率使用标准化检查表和全局分数对团队进行评分。结果83名外科、急诊、麻醉住院医师组成21个小组。专家评分者能够可靠地给这些场景打分。与7个启发式方案（分别为83.2%[11.7%]和6.6 [1.3]，P< 0.05）相比，团队完成较少的检查表动作，并且在3个分析方案上获得较低的总体得分（分别为73.8%[12.3%]和5.9[1.6]）。由资历较浅的居民领导的团队在分析情景上的整体得分（6.4[1.3]）高于资历较深的团队领导（5.3[1.7]）。结论本初步研究表明，老年人领导的团队在管理启发式情景时得分较高，但在管理需要更多分析方法的情景时效率较低。模拟可用于为团队提供创伤环境下的决策经验，并可用于提高诊断技能以及研究决策过程。
MethodsTen scenarios were developed to assess the ability of trauma teams to provide initial care to a severely injured patient. Seven standard scenarios simulated severe injuries that once diagnosed could be effectively treated using standard Advanced Trauma Life Support algorithms. Because diagnostic error occurs more commonly in complex clinical settings, 3 complex scenarios required teams to use more advanced diagnostic skills to uncover a coexisting condition and treat the patient. Teams composed of 3 to 5 practitioners were evaluated in the performance of 7 (of 10) randomly selected scenarios (5 standard, 2 complex). Expert rates scored teams using standardized checklists and global scores.ResultsEighty-three surgery, emergency medicine, and anesthesia residents constituted 21 teams. Expert raters were able to reliably score the scenarios. Teams accomplished fewer checklist actions and received lower global scores on the 3 analytic scenarios (73.8%[12.3%] and 5.9 [1.6], respectively) compared with the 7 heuristic scenarios (83.2%[11.7%] and 6.6 [1.3], respectively; P< 0.05 for both). Teams led by more junior residents received higher global scores on the analytic scenarios (6.4 [1.3]) than the more senior team leaders (5.3 [1.7]).ConclusionsThis preliminary study indicates that teams led by more senior residents received higher scores when managing heuristic scenarios but were less effective when managing the scenarios that require a more analytic approach. Simulation can be used to provide teams with decision-making experiences in trauma settings and could be used to improve diagnostic skills as well as study the decision-making process.