Just-in-Time Simulation to Guide Workflow Design for Coronavirus Disease 2019 Difficult Airway Management*
Just-in-Time Simulation to Guide Workflow Design for Coronavirus Disease 2019 Difficult Airway Management*
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DOI：
10.1097/pcc.0000000000002435
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发表时间：
2020-08-01
影响因子：
4.1
通讯作者：
Wolfe, Heather A.
中科院分区：
文献类型：
--
作者：
Daly Guris, Rodrigo J.;Doshi, Anushree;Wolfe, Heather A.
目的：2019年冠状病毒病大流行要求医院迅速调整工作流程和流程，以限制疾病传播并优化重症儿童的护理。设计和设置：作为我们机构2019年冠状病毒病重症监护工作流程设计过程的一部分，我们开发并进行了一些模拟练习，复杂性不断增加，逐渐发展到佩戴个人防护设备的插管，并最终激活了我们的困难气道团队以应对气道紧急情况。患者和干预措施：原位模拟用于识别和重新处理潜在的故障点，以指导2019年冠状病毒病疑似或阳性儿童的最佳气道管理。在这种高度真实的困难气道模拟之后，不到12小时后，一名疑似2019年冠状病毒病患者发生了真实的困难气道事件，验证了潜在的故障点和快速生成的指导的有效性。测量和主要结果：在桌面和基于人体模型的物理原位模拟过程中，确定了一些潜在的工作流程挑战。经验丰富的临床医生作为参与者，听取汇报，并提供反馈，这些反馈被纳入当地临床试验机构的临床路径、工作辅助工具和建议的实践中。对2019年疑似冠状病毒病的困难气道患者的临床管理显示出非常相似的成功和预期的失败点。在成功/失败网格的汇报和组装之后，使用这些模拟和临床经验创建了2019年冠状病毒病气道束模板，以供其他人适应他们的网站。结论：整合桌面规划、现场模拟和真实的2019冠状病毒病病例的汇报，可以加强规划、培训、工作辅助和可行的政策/程序，以解决2019冠状病毒病大流行时期的人为因素、团队沟通、设备选择和患者/提供者安全问题。
Objectives: The coronavirus disease 2019 pandemic has required that hospitals rapidly adapt workflows and processes to limit disease spread and optimize the care of critically ill children. Design and Setting: As part of our institution's coronavirus disease 2019 critical care workflow design process, we developed and conducted a number of simulation exercises, increasing in complexity, progressing to intubation wearing personal protective equipment, and culminating in activation of our difficult airway team for an airway emergency. Patients and Interventions: In situ simulations were used to identify and rework potential failure points to generate guidance for optimal airway management in coronavirus disease 2019 suspected or positive children. Subsequent to this high-realism difficult airway simulation was a real-life difficult airway event in a patient suspected of coronavirus disease 2019 less than 12 hours later, validating potential failure points and effectiveness of rapidly generated guidance. Measurements and Main Results: A number of potential workflow challenges were identified during tabletop and physical in situ manikin-based simulations. Experienced clinicians served as participants, debriefed, and provided feedback that was incorporated into local site clinical pathways, job aids, and suggested practices. Clinical management of an actual suspected coronavirus disease 2019 patient with difficult airway demonstrated very similar success and anticipated failure points. Following debriefing and assembly of a success/failure grid, a coronavirus disease 2019 airway bundle template was created using these simulations and clinical experiences for others to adapt to their sites. Conclusions: Integration of tabletop planning, in situ simulations, and debriefing of real coronavirus disease 2019 cases can enhance planning, training, job aids, and feasible policies/procedures that address human factors, team communication, equipment choice, and patient/provider safety in the coronavirus disease 2019 pandemic era.