Organizational strategies for improving evidence-uptake in intensive care

摘要 近几十年来，多项备受瞩目的临床试验为 需要机械通气的急性呼吸衰竭患者的护理。然而，许多患者仍然 没有接受这些被证明可以挽救生命的循证治疗。我们的首要目标是 研究计划是通过定义ICU组织之间的关系来解决这个问题， 重症监护中的行为和证据摄取。借鉴组织领域的快速发展， 心理学，决策科学和生物医学信息学，我们将广泛调查的方式， ICU团队成员的互动行为既可以促进也可以阻碍效率 将证据转化为实践。我们将追求三个综合和互补的路线， 研究：（1）开发和完善衡量重症监护绩效的新策略;（2） 调查集体智慧和交互记忆作为关键社会学中介的作用 重症监护中的证据摄取;（3）提高新型决策支持工具的价值， 作为使用循证实践的核对表和电子提示。执行此 我们将利用与州和地区卫生系统以及 主要研究者的专业知识，一位拥有15年以上研究经验的医生-科学家 重症监护室组织与危重病患者预后之间的联系。以上结果 将为医院和临床医生提供创新的工具，以提高重症监护的性能， 在全国范围内，直接改善急性呼吸衰竭和其他 各种形式的危重病。

ABSTRACT In recent decades multiple high-profile clinical trials have provided a rigorous evidence base for the care of patients with acute respiratory failure requiring mechanical ventilation. Yet many patients still do not receive these evidence-based treatments proven to save lives. The overarching goal of our research program is to address this issue by defining the relationship between ICU organizational behavior and evidence-uptake in critical care. Drawing off the rapidly evolving fields of organizational psychology, decision science, and biomedical informatics, we will broadly investigate the ways in which the interactive behaviors of the ICU team members can both facilitate and hinder efficient translation of evidence into practice. We will pursue three integrated and complimentary lines of research: (1) developing and refining novel strategies for measuring critical care performance; (2) investigating the role of collective intelligence and transactive memory as key sociological mediators of evidence-uptake in critical care; and (3) improving the value of novel decisional support tools such as checklists and electronic prompting for the use of evidence-based practice. To perform this research we will leverage existing collaborations with state and regional health systems as well as the expertise of the principal investigator, a physician-scientist with over 15 years’ experience studying the link between ICU organization and outcome for patients with critical illness. Together, our results will provide hospitals and clinicians with innovative tools for improving critical care performance on a national scale, directly leading improved outcomes for patients with acute respiratory failure and other forms of critical illness.