In situ simulation of neonatal resuscitation to improve team performance and clinical outcomes

新生儿复苏的原位模拟可提高团队绩效和临床结果

• 批准号: 9233469
• 负责人: Henry Chong Lee
• 金额: $ 33.55万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-05 至 2021-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9233469
• 关键词: 2 year old; Address; Admission activity; Adopted; Affect; Age-Months; Algorithms; Assessment tool; Behavioral; Bronchopulmonary Dysplasia; California; Caring; Cerebral Palsy; Clinic; Clinical; Clinical Data; Communities; Community Hospitals; Complex; Control Groups; Data; Data Collection; Data Set; Eligibility Determination; Enrollment; Environmental Risk Factor; Environmental air flow; Epinephrine; Equipment; Equipment and supply inventories; Evaluation; Face; Focus Groups; Group Interviews; Health Professional; Healthcare; Hospitalization; Hospitals; Human Resources; In Situ; Infant; Intervention; Knowledge; Learning; Link; Measures; Medical Care Team; Methodology; Modeling; Morbidity - disease rate; Nature; Neonatal; Neonatal Intensive Care Units; Neonatal Mortality; Network-based; Newborn Infant; Occupational Therapy; Outcome; Outcome Study; Participant; Patient Recruitments; Patients; Performance; Perinatal; Policies; Pregnancy; Premature Birth; Premature Infant; Qualitative Research; Quality of Care; Randomized; Recruitment Activity; Research; Research Design; Research Infrastructure; Research Project Grants; Resources; Resuscitation; Sampling; Science; Site; Site Visit; Source; Technical Expertise; Temperature; Testing; Time; Training; Training Programs; United States; Use Effectiveness; Video Recording; Work; collaborative care; contextual factors; cost; cost effectiveness; data resource; design; economic evaluation; follow-up; high risk infant; improved; individual patient; innovation; intraventricular hemorrhage; knowledge base; mortality; neonatal hypoxic-ischemic brain injury; neonatal morbidity; neonatal resuscitation; neonate; population based; pressure; primary outcome; programs; simulation; skills; survival outcome; tool

Project Summary Neonatal resuscitation can be challenging for healthcare teams due to its complex nature, requiring a combination of content knowledge, technical skills, behavioral skills, and teamwork. Simulation as a training tool can address this complex skill and also address the infrequent nature of resuscitations in conditions such as very preterm birth or hypoxic ischemic encephalopathy. While simulation is common in neonatal resuscitation training, the effectiveness of using simulation on actual clinical outcomes is unknown. We will test whether using in situ simulation training – simulation training in the actual setting that healthcare teams practice – improves team performance and clinical outcomes. This hypothesis will be tested in a stepped wedge trial in a large population-based quality improvement network. A stepped wedge trial allows for all participants to receive the intervention, and therefore increases recruitment ability and gives all participants to benefit from the intervention. In this design, the intervention is rolled out over time with some centers starting earlier than others. Each center is able to then serve as its own control, increasing the power to make comparisons. The setting of this research project will be the California Perinatal Quality Care Collaborative (CPQCC), a population-based network of neonatal intensive care units. CPQCC includes both academic and community units, which means that results will be generalizable. CPQCC already has an existing data infrastructure that includes maternal and neonatal data, including follow-up data at 2 years of age giving an opportunity to study outcomes that does not exist in similar networks. In this project, 40 hospitals will engage in a proven quality improvement model for neonatal resuscitation. In a stepwise fashion, each unit will learn and implement in situ simulation. The setting of the CPQCC allows for a unique opportunity to study the impact of training programs on important clinical outcomes for the most common cause of mortality and long-term morbidity in newborns, preterm birth. In Aim 1, we will assess whether in situ simulation improves clinical outcomes for preterm infants. In Aim 2, we will assess whether better team performance in simulation predicts better clinical outcomes. This will help to inform training methodologies and assessment in neonatal resuscitation. In Aim 3, we will examine facilitators and barriers of implementing simulation training across hospitals. This will inform the implementation of training programs across hospitals to improve neonatal resuscitation. In Aim 4, we will evaluate perform an economic evaluation of in situ simulation and implementation. The results of this research will provide a clearer understanding of how simulation can be used as an assessment tool, and more importantly the impact that it can have on improving clinical outcomes.

项目摘要 新生儿复苏由于其复杂的性质而对医疗团队可能会受到挑战，需要 内容知识，技术技能，行为技能和团队合作的结合。模拟作为培训 工具可以解决这一复杂技能，还可以解决复苏的不经常性质 作为非常早产或缺氧性缺血性脑病。而模拟在新生儿很常见 复苏训练，在实际临床结果上使用模拟的有效性尚不清楚。 我们将测试是否使用原位模拟训练 - 在实际环境中的模拟培训 医疗团队实践 - 改善团队绩效和临床成果。该假设将进行检验 在大型基于人群的质量改进网络中的梯级楔形试验中。阶梯楔试验 允许所有参与者接受干预，从而提高招聘能力并赋予所有人 参与者从干预中受益。在此设计中，随着时间的流逝，干预措施将与一些 中心比其他人早。每个中心都可以作为自己的控制，增加力量 进行比较。该研究项目的设置将是加利福尼亚围产期质量护理 协作（CPQCC），基于人群的新生儿重症监护病房网络。 CPQCC包括两者 学术和社区单位，这意味着结果将是可推广的。 CPQCC已经有一个 现有的数据基础架构，包括材料和新生儿数据，包括2岁的后续数据 提供了研究在类似网络中不存在的结果的机会。 在这个项目中，有40家医院将用于新生儿的良好质量改进模型 复苏。以逐步的方式，每个单元将学习和实现原位模拟。设置 CPQCC为研究培训计划对重要临床结果的影响提供了独特的机会 对于新生儿的死亡率和长期发病率的最常见原因，早产。在AIM 1中，我们将 评估原位模拟是否改善了早产儿的临床结果。在AIM 2中，我们将评估 模拟中更好的团队绩效是否可以预测更好的临床结果。这将有助于告知 新生儿复苏的培训方法和评估。在AIM 3中，我们将检查促进者和 跨医院实施模拟培训的障碍。这将告知实施培训 跨医院的计划，以改善新生儿复苏。在AIM 4中，我们将评估执行经济 评估原位模拟和实施。 这项研究的结果将对如何将模拟用作用作模拟有更清晰的了解 评估工具，更重要的是它对改善临床结果的影响。