Improving patient and clinician safety during COVID-19 through a rapidly adaptive simulation intervention

项目摘要-摘要 新型冠状病毒2019（COVID-19）大流行的延长反应增加了临床医生的工作 负担和感染风险，同时创造不确定的环境，特别是随着政府放松管制， 预计在不久的将来将采取封锁措施，并可能出现更多的感染高峰。系统 需要响应性和临床医生准备来防止对患者和工作人员的安全威胁。 快速发展的COVID-19患者护理指南导致在 床旁，提供了意外后果的机会，并引入了潜在的安全威胁。 临床医生暴露于急性职业应激事件可导致交感神经激活 系统，导致关键生理变化，包括心率变异性降低。重复或 持续的压力暴露，导致心率变异性降低，与医疗错误的增加有关， 患者满意度下降。模拟，一个将经验技术应用于实践的技术领域， 学习、评估、测试系统或人类行为，提供了一种经过验证的方法来改进系统 响应能力和流程改进。 我们最近开发并试行了一种新的快速适应性模拟干预措施， 采用和准备COVID-19护理交付。在这项工作的基础上，我们的总体目标是发展 并测试COVID-19应对干预：系统改进模拟（CRI：SIS），这是一个模拟- 基于培训和质量改进的干预措施，将最大限度地减少医生的压力，并改善系统 响应能力。为了实现这一目标，我们将首先确定促进因素、障碍和意外的安全风险 通过与急诊医生的深入访谈， 在护理重症COVID-19患者期间进行结构化实地观察。接下来，我们将进行两个现场 一项随机临床试验，以测试CRI的有效性：SIS作为基于模拟的准备干预， 通过以下方式减少艾德护理COVID-19患者期间的急诊医生压力和焦虑 心率变异性的轮班测量值作为压力和对状态的反应的生理标志- 轮班后特质焦虑量表。最后，我们将测试CRI：SIS作为一种过程改进策略， 与我们的部门合作，循环迭代基于模拟的指南测试和设计原型 管理员，衡量变化的AHRQ医院调查病人安全文化。我们将迅速 传播CRI：SIS作为两种模拟干预措施，一种是临床医生准备，另一种是系统 通过交互式虚拟远程模拟、网络研讨会和提供指导的虚拟研讨会进行改进 并为面临类似挑战的其他机构分享学习经验。如果证明成功，我们基于模拟的 CRI：SIS干预，以迅速准备临床医生和提高系统的反应能力，可以广泛 分发给其他机构，以应对预期的COVID-19安全挑战的漫长反应。

Project Summary-Abstract The extended response to the novel coronavirus 2019 (COVID-19) pandemic has increased clinician work burden and risk for infection while creating an environment of uncertainty, especially as easing of government lockdown measures and potential additional surges of infection are expected in the near future. System responsiveness and clinician preparedness are needed to prevent safety threats for both patients and staff. Rapidly evolving care guidelines for COVID-19 patients result in continuous changes to implementation at the bedside, presenting the opportunity for unintended consequences and the introduction of latent safety threats. Clinician exposure to acute occupational stress events can lead to an activation of the sympathetic nervous system, resulting in key physiologic changes including a decrease in heart rate variability. Repeated or continuous stress exposure, leading to lower heart rate variability, is linked to increased medical errors and decreased patient satisfaction. Simulation, a technical field that applies experiential techniques to practice, learn, evaluate, test, systems or human actions, provides a proven methodology for improving system responsiveness and process improvement. We recently developed and piloted a new rapidly adaptive simulation intervention to increase guideline adoption and preparedness for COVID-19 care delivery. Building upon this work, our overall goal is to develop and test the COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), a simulation- based training and quality improvement intervention that will minimize physician stress and improve system responsiveness. To accomplish this goal, we will first identify facilitators, barriers, and unintended safety risks in the adoption of new COVID-19 guidelines through in-depth interviews with emergency physicians and structured field observations during the care of critically ill COVID-19 patients. Next, we will conduct a two-site randomized clinical trial to test the efficacy of CRI:SIS as a simulation-based preparedness intervention on decreasing emergency physician stress and anxiety during the care of COVID-19 patients in the ED through on-shift measurements of heart rate variability as a physiologic marker of stress and responses to the State- Trait Anxiety Inventory post-shift. Finally, we will test CRI:SIS as a process improvement strategy through rapid cycle iterative loops of simulation-based testing of guidelines and design prototyping with our departmental administrators, measuring changes to the AHRQ Hospital Survey on Patient Safety Culture. We will rapidly disseminate CRI:SIS as two simulation interventions, one on clinician preparedness and the other on system improvement, through interactive virtual tele-simulations, webinars, and virtual workshops providing mentorship and shared learning for other institutions facing similar challenges. If proven successful, our simulation-based CRI:SIS intervention to rapidly prepare clinicians and improve system responsiveness can be widely disseminated to other institutions to combat the anticipated lengthy response to COVID-19 safety challenges.