Prehospital Activation of ED Teams to Improve Sepsis Care

院前激活急诊团队以改善脓毒症护理

• 批准号: 10455112
• 负责人: Ithan Daniel Peltan
• 金额: $ 19.24万
• 依托单位: IHC HEALTH SERVICES, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10455112
• 关键词: Accident and Emergency department; Acute; Address; Affect; Ambulances; Antibiotics; Award; Biostatistical Methods; Bypass; Caring; Clinical Data; Clinical Research; Clinical Trials; Clinical Trials Design; Cluster randomized trial; Code; Cognitive; Conduct Clinical Trials; Critical Care; Critical Illness; Cues; Data; Dedications; Development; Development Plans; Discipline; Early treatment; Effectiveness; Emergency Care; Emergency Department patient; Emergency Situation; Environment; Epidemiologic Methods; Evaluation; Face; Foundations; Functional disorder; Funding; Future; Goals; Government; Guidelines; Healthcare; Healthcare Systems; Hour; Human Resources; Infection; Infrastructure; Infusion procedures; International; Interview; K-Series Research Career Programs; Knowledge; Learning; Length of Stay; Link; Logistic Regressions; Logistics; Lung; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; Myocardial Infarction; Notification; Organ; Organ failure; Outcome; Pathway interactions; Patients; Pattern; Persons; Physicians; Pneumonia; Positioning Attribute; Predictive Value; Process; Protocols documentation; Research; Research Methodology; Research Personnel; Research Training; Resource Development; Resources; Risk Assessment; Scientist; Sepsis; Severity of illness; Speed; Statistical Methods; Stroke; Structure; Syndrome; System; Testing; Time; Time trend; Training; Trauma; Triage; United States; Variant; advanced analytics; analytical method; base; care delivery; care systems; career; career development; clinical decision support; clinical investigation; cognitive task; cohesion; cohort; cost; design; experience; high risk; implementation science; improved; infection risk; innovation; mortality; multidisciplinary; novel; novel strategies; overtreatment; post implementation; predictive modeling; programs; prospective; randomized trial; rapid diagnosis; research and development; response; septic patients; skills; skills training; success; task analysis; wasting

PROJECT SUMMARY/ABSTRACT Support from this Mentored Career Development Award will provide Ithan Peltan, MD, MSc the additional skills and training he needs to succeed in his goal of becoming an independent physician-scientist focused on improving early sepsis care. Dr. Peltan is a board-certified pulmonary and critical care physician at Intermountain Healthcare with a track record of research success, proven dedication to clinical investigation, and an excellent foundation in methods for high-quality clinical research. This proposal will complete Dr. Peltan’s transition to research independence via a structured career development plan that builds on his prior training and experience and leverages an environment with rich research and career development resources as well as access to granular multicenter clinical data. Specific learning objectives include (1) advanced epidemiologic and biostatistical methods; (2) implementation science and associated methodologies; and (3) the design and conduct of clinical trials. Dr. Peltan will acquire these new skills and knowledge by means of formal coursework, professional development training, and an innovative program of mentored research that will advance medical knowledge about sepsis and identify strategies to facilitate delivery of high-quality sepsis care in the emergency department. Dr. Peltan’s career development will be guided by an experienced and cohesive multidisciplinary mentorship team with expertise in critical care, emergency and prehospital research, sepsis, implementation science, clinical trials, and advanced analytic methods. Sepsis causes or complicates hospital stays for over 1 million U.S. patients every year, with mortality of 15- 20%. Early, appropriate antibiotics are critical to optimal sepsis outcomes. Many patients who present to the emergency department (ED) with sepsis, however, do not receive antibiotics within the intervals recommended by international guidelines and required under government standards. Given the barriers to accomplishing timely antibiotics using current care models, new approaches to ED sepsis care are urgently needed. The research planned for this K23 award aims to (1) validate methods to identify patients likely to have sepsis at or before ED arrival and (2) understand the unintended consequences of care systems that prioritize rapid antibiotic imitation for sepsis in order to (3) test whether redesigning ED sepsis care around multidisciplinary “Code Sepsis” teams activated on or before patient’s ED arrival could improve delivery of high-quality sepsis care. Importantly, this proposal addresses questions and develops methods applicable to care delivery for other high-risk critical illnesses. Findings from this research will provide the preliminary data for R01 or equivalent funding to support a multicenter cluster-randomized trial of the Code Sepsis protocol.

项目总结/摘要 从这个指导职业发展奖的支持将提供伊桑佩尔坦，医学博士，理学硕士的额外技能 和培训，他需要成功地在他的目标，成为一个独立的物理学家，科学家专注于 改善早期脓毒症护理。Peltan博士是一名委员会认证的肺部和重症监护医生， Intermountain Healthcare拥有成功的研究记录，对临床研究的奉献精神， 并为高质量临床研究的方法奠定了良好的基础。这将完成博士。 Peltan通过一个结构化的职业发展计划向研究独立的过渡，该计划建立在他之前的基础上。 培训和经验，并利用丰富的研究和职业发展资源的环境 以及获得多中心临床数据的途径。具体学习目标包括：（1）高级 流行病学和生物统计学方法;（2）实施科学和相关方法;以及（3） 临床试验的设计和实施。Peltan博士将通过以下方式获得这些新技能和知识 正式的课程，专业发展培训，以及指导研究的创新计划， 将推进关于脓毒症的医学知识，并确定促进提供高质量脓毒症的策略， 在急诊室护理。Peltan博士的职业发展将由一位经验丰富， 具有凝聚力的多学科指导团队，在重症监护，急诊和院前研究方面具有专业知识， 败血症，实施科学，临床试验和先进的分析方法。 脓毒症导致每年超过100万美国患者住院或使其复杂化，死亡率为15 - 100%。 百分之二十早期，适当的抗生素对最佳脓毒症结局至关重要。许多病人谁提出的 然而，患有脓毒症的急诊科（艾德）在推荐的间隔内不接受抗生素 根据国际准则和政府标准的要求。考虑到完成任务的障碍 使用当前的护理模式及时使用抗生素，迫切需要艾德脓毒症护理的新方法。的 这项K23奖计划的研究旨在（1）验证方法，以确定可能患有败血症的患者， 在艾德到来之前，（2）了解护理系统的意外后果， 抗生素模拟脓毒症，以（3）测试是否围绕多学科重新设计艾德脓毒症护理 在患者到达艾德时或之前启动"脓毒症代码"团队可以改善高质量脓毒症的交付 在乎重要的是，该提案解决了以下问题并制定了适用于护理提供的方法： 其他高危重症。这项研究的结果将为R01或R02提供初步数据。 相等的资金，以支持代码脓毒症协议的多中心群集随机试验。