Clinical outcomes of simulation training_Sedation Information Management System

模拟训练临床效果_镇静信息管理系统

• 批准号: 8268282
• 负责人: Zeev Kain
• 金额: $ 35万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8268282
• 关键词: Clinical; outcomes; simulation; training_Sedation; Information

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.

描述（由申请人提供）：目前在美国有数百万患者使用镇静剂，侵入性医疗程序的扩散将导致 导致该技术的使用进一步增加。虽然镇静具有许多优点，例如确保患者舒适和控制疼痛，但它也与潜在的并发症有关，包括在患者充分镇静之前开始的手术、缺氧和心脏骤停。在医疗保健机构中使用镇静剂的主要挑战之一是这种做法的脱节性，通常包括多名专科医生，他们在各种环境下以不同的技能组合和使用各种协议来实施镇静剂。目前提供镇静的培训也没有标准化 每个机构都可以根据医务人员政策自由制定自己的培训计划，并且大多数医院（仅）要求镇静提供者对所用药物的药理学等问题进行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培训将是理想的选择。然而，仍然有一个 缺乏直接证据表明模拟训练可以改善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 计划，然后使用镇静信息管理系统 (SIMS) 测试该计划，该系统将捕获连续的生命体征以及患者安全和质量结果数据。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 镇静服务中心密切合作，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，旨在加强非麻醉医师对成年患者的中度镇静管理。第二阶段：形成性评估：在一系列焦点小组中检查这种干预措施的可行性和实用性。第三阶段：功效随机对照试验：检验这种干预措施提高医疗保健提供者群体的技术和非技术技能的能力，为接受侵入性手术的成人提供适度镇静。第四阶段：全院试验：采用前后研究设计 在整个医院实施干预，并收集前瞻性临床发病率和死亡率结果数据，例如一年内使用 SIMS 对 5000 多名接受镇静的患者进行缺氧的发生率。事实证明，这种干预措施将减少我们医院与镇静相关的发病率；总体目标是美国所有提供适度镇静的医疗机构采用这一新开发的模拟训练计划。这将通过传播这项研究结果以及寻求 AHRQ、JACHO 和 CMS 等组织的认可来完成。 公共健康相关性：本项目旨在开发一个基于高保真度的教育计划，用于培训实施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，其中许多患者会出现心脏骤停等并发症。该镇静计划显着解决了公共卫生问题，旨在通过提供一个可以得到各个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。