The simulation-derived algorithm: a better method to achieve a performance consensus.
The simulation-derived algorithm: a better method to achieve a performance consensus.
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模拟衍生算法：实现性能共识的更好方法。
DOI：
10.1097/aln.0b013e31826903e0
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发表时间：
2012
期刊：
影响因子：
8.8
通讯作者：
Murray,DavidJ
中科院分区：
文献类型：
--
作者：
Murray,DavidJ
最近，Balki 等人开发并研究了一种针对产科患者意外困难气道的算法，该算法产生的结果强调了如何使用模拟来制定管理罕见事件的前瞻性专家共识。这项研究展示了如何使用模拟来开发和完善算法，然后将其应用于推进麻醉实践。此类场景应包含专家商定的主题并由麻醉师管理。专家共识将表明关于关键条件管理的一致意见或广泛分歧，并将定义每种情况的管理期望。这种方法能够克服回顾性方法中发现的事后偏见，并且可以确定诊断、治疗、沟通和团队合作步骤的顺序。当放入实时场景时，可以对这些步骤的时间安排和顺序进行细化。一个问题是，算法中并未考虑团队合作的所有细微差别，并且路径可能会变得固定而不是动态。 Balki 等人通过与团队成员协商来解决这个潜在问题，但沟通的重要性可能被低估了。在考虑胎儿和孕产妇风险时，产科、新生儿和护理人员之间的沟通至关重要。 Balki 等人为使用模拟设计护理算法提供了一个重要的方法框架。
Recently, Balki et al developed and studied an algorithm for the unanticipated difficult airway in obstetric patients which produced results highlighting how simulation can be used to develop a prospective expert consensus for managing rare events. This study showed how simulations can be used to develop and refine algorithms which can then be applied to advance anesthesia practice. Such scenarios should consist of subject matter agreed upon by experts and managed by anesthesiologists. Expert consensus will either demonstrate the unanimity of opinion or the breadth of differences concerning the management of critical conditions and will define the management expectations of each scenario. This approach has the ability to overcome hindsight bias found with retrospective approaches and can identify the sequence of diagnostiC, therapeutiC, communication, and teamwork steps. These steps can be refined in their timing and sequence when put into a real-time scenario.One concern is that not all nuances of teamwork may be considered in the algorithm and the path could become fixed rather than dynamic. Balki et al address this potential issue by including consultation with team members, but the importance of communication may be underestimated. Communication between obstetriC, neonatal, and nursing members is essential when considering fetal and maternal risk. Balki et al have provided an important and methodological framework for using simulation in designing algorithms for care.