Clinical outcomes of simulation training_Sedation Information Management System

描述（由申请人提供）：在美国，患者镇静目前用于数百万患者，并且侵入性医疗程序的扩散将 这将进一步增加这项技术的使用。虽然镇静提供了许多优点，例如确保患者的舒适度和疼痛控制，但它也与潜在的并发症有关，从在患者充分镇静之前开始的手术到缺氧和心脏骤停。在医疗保健机构的背景下，镇静的主要挑战之一是这种实践的脱节特征，其通常包括在各种设置中以不同的技能集和使用各种协议来管理镇静的多个子专家。提供镇静剂的培训目前也没有标准化 并且每个机构都有基于医务人员政策创建其自己的培训计划的自由，并且大多数医院要求镇静提供者（仅）经历关于诸如所使用药物的药理学的问题的书面或基于网络的测试。另一方面，模拟技术正在迅速成为医学教育和熟练培训的标准，将这些技术纳入镇静训练是理想的。然而，仍然有一个 缺乏直接证据表明模拟训练改善了实际的患者安全结果。本申请中概述的研究的总体目标是开发一种创新的镇静训练方法， 程序，然后使用镇静信息管理系统（西姆斯）测试程序，该系统将捕获连续的生命体征和患者安全性和质量结果数据。该应用程序包括四个阶段：第一阶段：干预开发：通过与UCI医学教育模拟中心和UCI镇静服务的密切合作，开发干预（培训计划），其中包括高保真模拟组件和基于网络的认知组件，旨在增强非麻醉师对成人患者中度镇静的管理。第二阶段：形成性评估：在一系列焦点小组中检查这种干预的可行性和实用性。第三阶段：疗效RCT试验：检查这种干预措施在为接受侵入性手术的成人提供适度镇静的医疗保健提供者人群中提高技术和非技术技能的能力。第四阶段：医院范围试验：使用前后研究设计，在我们医院实施干预，并收集前瞻性临床发病率和死亡率结果数据，例如在一年内使用西姆斯的缺氧发生率，超过5000名患者接受镇静。在证明这种干预将导致我们医院的镇静相关发病率降低之后;总体目标是在美国所有提供中度镇静的医疗保健机构中采用这种新开发的模拟培训计划。这将通过传播这项研究的结果以及寻求AHRQ、JACHO和CMS等组织的认可来实现。 公共卫生相关性：本项目旨在开发一个高保真的教育计划，用于培训管理程序镇静的医疗保健提供者。每年有数百万患者接受手术镇静，许多患者与心脏骤停等并发症有关。这一镇静计划显著解决了公共卫生问题，旨在通过提供一个可以得到各监管机构认可并在美国所有医院实施的框架来提高患者安全性。

DESCRIPTION (provided by applicant): Sedation of patients is currently used for many millions of patients in the United States and the proliferation of invasive medical procedures will result in further increase in the use of this technique. While sedation offers many advantages such as assuring comfort of the patient and pain control, it is also associated with potential complications ranging from a procedure that is started before a patient is adequately sedated to hypoxia, and cardiac arrest. One of the main challenges with sedation within the context of a health care facility is the disjointed character of this practice, which typically includes multipl subspecialists who administer sedation in a variety of settings with different skill sets and the use of various protocols. Training for the provision of sedation is currently also not standardized and each institution has the freedom to create its own training program based on medical staff policies and most hospitals require sedation providers (only) to undergo a written or web-based test on issues such as pharmacology of the drugs to be used. Simulation techniques, on the other hand, are quickly becoming the standard in medical education and proficiency training and it would be ideal to incorporate these techniques into sedation training. However, there is still a paucity of direct evidence that simulation training improves actual patient safety outcomes. The overall aim of the study outlined in this application is to develop an innovative sedation-training program and then test the program using a Sedation Information Management System (SIMS) that will capture continuous vital signs and patient safety and quality outcome data. This application consists of four phases: Phase I: Intervention Development: Through a close collaboration with UCI Medical Education Simulation Center and UCI Sedation Services, develop an intervention (training program) that will include both a high fidelity simulation component and web based cognitive component that will be directed at enhancing the management of moderate sedation for adult patients by non-anesthesiologists. Phase II: Formative Evaluation: Examination of the feasibility and utility of this intervention in a series o focus groups. Phase III: Efficacy RCT Trial: Examine the ability of this intervention to improve both technical and non-technical skills in a population of healthcare providers delivering moderate sedation to adults undergoing invasive procedures. Phase IV: Hospital-Wide Trial: Using a before- after study design Implement the intervention throughout our hospital and collect prospective clinical morbidity and mortality outcome data such as incidence of hypoxia with the use of SIMS over a period of one year with over 5000 patients undergoing sedation. Following demonstration that this intervention will lead to reduced sedation associated morbidity in our hospital; the overall goal is the adoption of this newly developed simulation training program by all health care facilities in the US that provide moderate sedation. This will be done through dissemination of the results of this research as well seeking the endorsement of organizations such as AHRQ, JACHO and CMS. PUBLIC HEALTH RELEVANCE: The present project seeks to develop a high-fidelity based education program for training of healthcare providers who administer procedural sedation. Every year millions of patients undergo procedural sedation and many are associated with complications such as cardiac arrest. This sedation program significantly addresses a public health concern and aims to improve patient safety by providing a framework that can be endorsed by various regulatory agencies and put into place in all hospitals in the US.