Using Military & Aviation Simulation Experience to Impr*

描述（由申请人提供）：劳动和交付单位是高风险，高成本的环境中，决策，错误和延误可能会产生悲惨的后果。在我国的农村医院，工作人员必须拥有管理产科急诊所需的技能和资源，尽管这些事件并不频繁。该项目的目标是将在航空、军事、麻醉和其他有限的医学领域得到验证的模拟技术和团队绩效培训用于改善产科护理流程，并促进农村社区的安全。 在美国，每天有超过75名婴儿死亡。JCAHO估计，三分之二的新生儿死亡或分娩期间永久性残疾可归因于人为因素，如沟通错误，近一半是由于工作人员的能力问题。农村医院资源有限，提供者很少，在按照《紧急医疗和劳动法》的要求提供紧急产科服务方面面临相当大的挑战。这种要求严格的结构要求护士和支持人员保持产科的技能水平和临床能力，尽管实践经验有限，但提供了理想的环境，通过产科团队模拟来提高安全性。船员资源管理（CRM）（AHRQ证据报告第43号，第44章）和医疗模拟（AHRQ证据报告第43号，第45章）已被IOM，JCAHO和AHRQ推荐为安全实践干预措施，以减少与护理过程相关的错误和风险。该提案结合了NASA和美国军方的机组人员资源管理和模拟专业知识，学术界的教育和研究专业知识，以及所有三个方面的安全重点，将模拟带到迫切需要的地方：美国农村的临床护理前线。具体来说，我们的目标是测试模拟产科急诊和团队绩效培训（CRM）是否会通过以下AIMS改善农村医院环境中的护理过程和患者安全： I.开发和测试标准化课程，用于模拟产科紧急反应演习和安全CORDS 二.在农村地区实施和评估社区发展战略 三.探索IT创建全州安全文化和扩大模拟范围的能力。 该项目的成果将：1）提供一个工具包，可用于全国各地，以改善护理过程和促进安全，2）演示如何使用IT和模拟教育，以支持全州范围内的安全文化和3）模型如何利用和评估模拟的有效性，以保持技术技能水平，并加强农村医疗保健系统的护理和安全过程。

DESCRIPTION (provided by the applicant): Labor and delivery units are high-risk, high-cost environments in which decisions, mistakes, and delays can have tragic consequences. In our nation's rural hospitals, staff must possess the skills and resources needed to manage obstetric emergencies despite the infrequency of these events. The goal of this project is to bring simulation technology and team performance training, proven in aviation, the military, anesthesia, and other limited areas of medicine, to improve the process of obstetric care and promote safety in rural communities. More than 75 infants die each day in the United States. JCAHO estimates that 2/3 of cases of neonatal death or permanent disability during childbirth are attributable to human factors such as communication errors and almost half due to issues of staff competency. Rural hospitals with limited resources and few providers face considerable challenges in providing emergency obstetric services as required by the Emergency Medical Treatment and Labor Act (EMTALA). This demanding structure requiring nurses and support staff to maintain skill levels and clinical competency in obstetrics despite limited hands-on experience, offers the ideal setting to improve safety through obstetric team simulations. Crew resource management (CRM) (AHRQ Evidence Report number 43, Chapter 44) and medical simulations (AHRQ Evidence Report number 43, Chapter 45), have been recommended by the IOM, JCAHO, and AHRQ as safe practice interventions to reduce errors and risks associated with the process of care. This proposal combines crew resource management and simulation expertise from NASA and the U.S. military, educational and research expertise from academia, and the safety focus of all three to bring simulations where they are desperately needed: to the frontline of clinical care in rural America. Specifically, we aim to test whether simulation of obstetric emergencies and team performance training (CRM) will improve the process of care and patient safety in rural hospital settings through the following AIMS: I. Develop and test standardized Curricula for simulated Obstetric emergency Response Drills & Safety-CORDS II. Implement and evaluate CORDS in rural settings III. Explore the ability of IT to create a statewide safety culture and to expand the reach of simulations. The results of this project will: 1) provide a toolkit that can be used across the country to improve the process of care and promote safety, 2) demonstrate how to use IT and simulated education to support a statewide safety culture and 3) model how to utilize and evaluate the effectiveness of simulations to maintain technical skill levels and enhance the process of care and safety in rural healthcare systems.