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

项目摘要-摘要 对新型冠状病毒2019(新冠肺炎)大流行的延长反应增加了临床医生的工作 造成感染的负担和风险，同时创造不确定的环境，特别是在放松政府政策的情况下 预计在不久的将来，将采取封锁措施，并可能出现额外的感染激增。系统 需要反应能力和临床医生的准备，以防止对患者和工作人员的安全威胁。 快速发展的新冠肺炎患者护理指南导致在 在床边，有可能产生意想不到的后果并带来潜在的安全威胁。 临床医生暴露在急性职业紧张事件中会导致交感神经的激活 导致关键的生理变化，包括心率变异性的降低。重复或 持续的压力暴露，导致较低的心率变异性，与增加医疗差错和 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，为改进系统提供经过验证的方法 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自适应模拟干预以增加指导方针 新冠肺炎护理服务的采用和准备情况。在此基础上，我们的总体目标是发展 并测试新冠肺炎响应性干预：系统改进模拟(CRI：SIS)，模拟- 以培训和质量改进为基础的干预措施将最大限度地减少医生的压力并改善系统 响应性。为了实现这一目标，我们将首先确定促进者、障碍和意外的安全风险 通过对急诊医生和 新冠肺炎危重患者护理过程中的结构化现场观察。接下来，我们将进行两个站点的 随机临床试验以测试CRI：SIS作为基于模拟的准备干预的有效性 通过减少急诊室新冠肺炎患者护理中急诊医生的压力和焦虑 轮班测量心率变异性作为压力和对状态反应的生理标志- 班次后特质焦虑量表。最后，我们将通过RAPID测试CRI：SIS作为过程改进策略 与我们部门一起进行基于模拟的指南测试和设计原型的循环迭代循环 管理人员，衡量AHRQ医院对患者安全文化的调查的变化。我们将迅速 传播CRI：SIS作为两种模拟干预，一种针对临床医生准备，另一种针对系统 通过交互式虚拟远程模拟、网络研讨会和提供指导的虚拟讲习班进行改进 并为面临类似挑战的其他机构分享学习。如果证明成功，我们基于模拟的 CRI：SIS干预可广泛用于快速为临床医生做好准备并提高系统响应能力 向其他机构传播，以应对预期的漫长的新冠肺炎安全挑战。

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.