Improving patient safety with just-in-time pediatric simulation training

描述(由申请人提供)：先进的儿科呼吸道管理是优化儿童治疗的关键。我们的长期目标是在先进的儿科呼吸道管理过程中提高患者的安全性。安全的气管插管程序需要复杂的个人和多学科团队技能，这些技能在儿科重症监护病房(PICU)教授和学习。使用由我们的研究团队专门为儿童改编的国家急救航空注册中心(NEAR)提供的强有力的初步数据表明，插管成功和不良事件与很少执行这一程序的受监督见习医生有关，他们的表现不如同样受到监督但经验丰富的尖端提供者安全。本建议的目的是评估“适时”模拟过度训练对先进的呼吸道管理的安全性和有效性的影响。我们的模拟、高级教育和创新中心开发了模拟工具，以增强自我效能、能力和团队沟通。这项前瞻性的干预性研究将在儿科ICU中随机将被指派管理呼吸道紧急情况的尖端提供者随机分为不过度训练和20分钟低保真或高保真模拟过度训练，具体目的有两个：1)评估“即时”模拟过度训练的有效性；2)评估高保真模拟与低保真模拟对患者安全结果的影响。模拟和实际患者的气管插管将使用NEAR工具进行评估，首次尝试气管插管成功的主要结果和与气管插管相关事件的次要结果将通过我们的研究团队开发和验证的技术进行严格分析。与机构使命相关：如果对锐端提供者的模拟过度培训提高了实际患者的安全，我们的医院组织将迅速实施并跟踪这些教育工具在实践中的安全影响。将向提供者、健康教育者、付款人、政策制定者、患者、公众和AHRQ了解如何在不同的医疗保健环境中改善安全医疗服务的提供。安全、先进的儿科呼吸道管理需要有经验和训练有素的提供者。如果这项研究证明模拟过度训练提高了安全性，这些技术将被采用并在不同的高危环境中实施，以改善对危重儿童的护理。

DESCRIPTION (PROVIDED BY THE APPLICANT): Advanced pediatric airway management is critical for optimized treatment of children. Our long-term goal is to improve patient safety during advanced pediatric airway management. Safe tracheal intubation procedures require sophisticated individual and multidisciplinary team skills that are taught and learned in the pediatric intensive care unit (PICU). Strong preliminary data using the National Emergency Airway Registry (NEAR) specifically adapted for children by our research team demonstrates that intubation success and adverse events are associated with supervised physician trainees who rarely perform this procedure, and their performance is not as safe as identically supervised but experienced sharp end providers. The objective of this proposal is to evaluate the effect of "just-in-time" simulation overtraining on safety and efficacy of advanced airway management. Our Center for Simulation, Advanced Education and Innovation has developed simulation tools that enhance self-efficacy, competence, and team communication. This prospective, interventional study will randomize sharp end providers assigned to manage airway emergencies in the pediatric ICU to either no overtraining versus 20 minutes of either low fidelity or high fidelity simulation overtraining with two specific aims: 1) To evaluate the efficacy of "just-in-time" simulation overtraining; and 2) To evaluate the impact of high versus low fidelity simulation on patient safety outcomes. Both simulated and actual patient tracheal intubations will be evaluated using the NEAR tool, and the primary outcome of tracheal intubation success on first attempt and secondary outcomes of tracheal intubation associated events will be rigorously analyzed by techniques developed and validated by our research team. Relevance to the agency mission: If simulation overtraining of sharp end providers improves actual patient safety, our hospital organization will rapidly implement and track the safety impact of these education tools in practice. Providers, health educators, payers, policy makers, patients, the public and AHRQ would be informed on how to improve the delivery of safe health care across diverse healthcare settings. Safe advanced pediatric airway management requires experienced and trained providers. If this study demonstrates that simulation overtraining improves safety, these techniques will be adopted and implemented in diverse high-risk settings to improve the care of critically ill children.